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http://www.archive.org/details/mortalityfromcanOOhoff 


THE  MORTALITY 

FROM   CANCER  THROUGHOUT 

THE  WORLD 


FREDERICK  L.  HOFFMAN,  LL.D., 

F.S.S.,   F.A.S.A. 

Statistician   The   Prudential  Insurance   Company   of  America;    Chairman   Com- 
mittee on  Statistics,  American  Society  for  the  Control  of  Cancer;  Member 
American  Association  for  Cancer  Research;  Associate  Fellow  American 
Medical  Association;  Associate   Member   American  Academy 
of  Medicine,  etc.,  etc. 


Newark,  New  Jersey 

THE   PRUDENTIAL    PRESS 
1915 


(riven  by  Fjitlixh^r. 

MAY  I  5  M« 


Copyright,  1916 

By  THE  PRUDENTIAL  INSURANCE  COMPANY 

OF  AMERICA 

Newark,  New  Jebset 


■RCt-GI 

Copu 


TO 

The  American  Society  for  the 
Control  of  Cancer 

AND 

The  American  Association  for 
Cancer  Research 


FREDERICK  L.  HOFFMAN  jHE   PRUDENTIAL   INSURANCE    COMPANY 

STATISTICIAN 

OF  AMERICA 
HOME  OFFICE,  NEWARK.  NEW  JERSEY 

May  10,  1915. 
Mr.  Forrest  F.  Dryden,  President. 
Dear  Mr.  Dryden: 

Nearly  two  years  ago  an  invitation  was  extended  to  me  by  the 
president  of  the  New  Jersey  Academy  of  Medicine,  Dr.  Edward  J.  Ill,  of 
Newark,  to  address  that  society  on  some  subject  of  my  own  selection. 
After  careful  consideration  I  agreed  upon  a  discussion  of  "The  Menace  of 
Cancer,"  as  in  the  light  of  our  own  experience  perhaps  the  most  important 
medical  problem  demanding  special  attention  along  lines  of  public 
and  individual  control.  This  subject  had  for  some  years  past  been 
given  more  or  less  consideration  as  one  of  increasing  significance  in  life 
insurance  medicine,  best  emphasized  in  the  statement  that  at  ages  forty- 
five  and  over,  in  our  Ordinary  experience  of  1914,  9.6  per  cent,  of  the 
deaths  of  males  and  18.6  per  cent,  of  the  deaths  of  females  were  the 
result  of  malignant  disease. 

The  address  was  delivered  on  March  26,  1913,  and  subsequently, 
upon  the  urgent  invitation  of  the  American  Gynecological  Society,  was, 
with  many  additions  and  new  illustrations,  brought  before  that  im- 
portant body,  at  a  meeting  held  in  Washington  on  May  7,  1913. 
Some  time  previous,  however,  steps  had  been  taken  to  develop 
an  organized  effort  for  a  nation-wide  educational  cancer  movement, 
and  accordingly,  on  May  22,  1913,  the  American  Society  for  the  Con- 
trol of  Cancer  was  formed.  This  association  has  since  become  an  in- 
fluential body,  aiming  primarily  at  the  widest  possible  dissemination 
of  the  salient  facts  of  the  cancer  problem  and  the  clear  recognition  on  the 
part  of  the  public  of  the  supreme  importance  of  the  earliest  possible 
diagnosis  and  the  qualified  treatment  of  the  disease  in  its  initial  stage. 
The  public  aspects  of  the  cancer  question  are  best  emphasized  in  the 
statement  that  the  mortality  from  cancer  in  the  Continental  United 
States  now  exceeds  80,000  per  annum,  and  that  the  rate  of  mortality 
from  this  disease  is  increasing  approximately  2.5  per  cent,  per  annum. 
A  considerable  proportion  of  the  mortality  is,  in  part  at  least,  directly 
attributable  to  public  ignorance  and  neglect  of  known  measures  and 
means  by  which  the  mortality  can  be  materially  reduced. 

In  the  organization  of  the  American  Society  for  the  Control  of  Cancer 
I  was  honored  with  the  position  of  Chairman  of  the  Committee  on  Sta- 
tistics. The  additional  members  of  this  Committee  are  Dr.  James 
Ewing  of  the  Cornell  Medical  School,  New  York  City,  and  Dr.  Joseph  C. 
Bloodgood  of  The  Johns  Hopkins  Hospital,  Baltimore.  The  Committee 
has  given  extended  consideration  to  many  important  statistical  ques- 
tions; but  it  was  early  realized  that  the  efforts  of  the  Society  would  be 
materially  advanced  by  a  concise  presentation  of  the  statistical  evidence 
regarding  cancer  frequency  throughout  the  United  States  and  the  re- 
mainder of  the  civilized  world.  The  need  of  trustworthy  statistical 
information  was  especially  realized  in  connection  with  the  work  of  local 
committees  and  the  nation-wide  effort  to  place  the  salient  facts  of  the 
existing  cancer  situation  before  the  public  in  a  readily  comprehended 
form.     In  aid  of  this  educational  propaganda  I  have  had  occasion  to 


address  many  such  meetings  throughout  the  country,  and  naturally  in 
each  and  every  case  my  own  observations  and  conclusions  were  chiefly 
sustained  by  an  appeal  to  the  actual  facts  of  cancer  occurrence  in  the 
locality  or  sections  in  which  the  meetings  were  held. 

A  large  amount  of  exceptionally  useful  statistical  information  was  thus 
brought  together,  and  since  the  material  would  unquestionably  be  of 
great  practical  value,  not  only  to  those  directly  interested  in  cancer 
education,  but  also  to  the  medical  profession  generally  and  to  specialists 
engaged  in  cancer  research,  it  seemed  but  a  pubhc  duty  on  our  part  to 
make  the  data  more  generally  accessible  to  the  public  at  large.  The 
suggestion  was  therefore  brought  to  your  attention,  and  you  were  good 
enough  to  approve  of  my  recommendation  that  a  work  of  this  character 
should  be  published  by  The  Prudential,  as  perhaps  the  most  substantial 
aid  to  be  rendered  by  the  Company  in  the  furtherance  of  the  cause  of 
cancer  control.  The  broadening  of  the  plan  and  scope  of  the  original 
inquiry  has  expanded  the  work  into  one  of  considerable  size,  but  the 
general  usefulness  of  the  results  has  thereby  been  proportionately  in- 
creased. 

The  entire  matter  is  now  resubmitted  to  you  for  your  final  approval, 
with  the  suggestion  that  the  work  be  dedicated  to  the  American  Society 
for  the  Control  of  Cancer  and  the  American  Association  for  Cancer 
Research.  It  is  further  recommended  that  the  work  be  made  available 
for  gratuitous  distribution,  with  the  compliments  of  The  Prudential,  to 
medical  libraries,  members  of  the  medical  and  surgical  professions,  and 
to  all  others  especially  interested  in  the  cancer  cause  and  the  problem 
of  cancer  control. 

In  conclusion,  I  make  use  of  this  opportunity  to  express  to  you  my 
sincere  personal  appreciation  of  the  broad-minded  position  which  The 
Prudential  has  taken  in  this  as  well  as  many  other  questions  relating  to 
the  activities  of  health-promoting  agencies.  In  the  furtherance  of 
nation-wide  efforts  to  reduce  mortality  and  to  prolong  the  duration 
of  human  life  we  have  frequently  been  able  to  render  scientific  assistance 
of  practical  and  permanent  value.  I  feel  sure,  however,  that  whatever 
we  may  have  done  in  the  past,  especially  as  regards  our  cooperation  in 
the  campaign  against  tuberculosis;  in  the  prevention  of  industrial 
accidents;  and  in  the  gradual  reduction  of  the  mortality  from  acute 
infectious  diseases  of  infancy,  etc.,  the  service  which  the  present  publi- 
cation will  render  in  the  world-wide  quest  for  the  whole  truth  of  the 
cancer  problem  and  the  effective  control  of  malignant  disease  is  certain 
to  prove  the  most  substantial  of  all. 

I  remain  very  truly  yours. 


Approved : 


Statistician. 


/  President. 


PREFACE 

The  practical  importance  of  cancer  to  life  insurance  companies  is 
precisely  shown  in  the  statement  that  out  of  5,529  deaths  from  all 
causes  in  the  Ordinary  experience  of  The  Prudential  during  1914,  416 
deaths,  or  7.5  per  cent.,  were  from  malignant  disease,  or  6.4  per  cent, 
of  the  mortality  of  males  and  12.0  per  cent,  of  the  mortality  of  females. 
Limited  to  ages  forty-five  and  over,  the  Ordinary  experience  of  the 
Company  for  the  year  1914  shows  that  of  the  deaths  of  males  9.6  per 
cent,  were  from  cancer,  against  18.6  per  cent,  of  the  mortality  of  females. 
Cancer  was  the  third  most  important  cause  of  death  among  males  at 
ages  forty-five  and  over,  and  the  leading  cause  of  death  in  the  corre- 
sponding mortality  of  insured  women.  The  exceptional  importance, 
therefore,  of  the  cancer  problem  to  life  insurance  companies  will  not  be 
called  into  question  by  any  one  familiar  with  the  general  facts  of  the 
cancer  situation  and  aware  of  the  lamentable  truth  that  there  are  now 
annually  over  80,000  deaths  from  malignant  disease  in  the  Continental 
United  States  and  that  the  disease  is  increasing  at  the  approximate  rate 
of  2.5  per  cent,  per  annum.  If  the  present  rate  of  increase  continues  un- 
checked, the  annual  cancer  mortality  in  the  Continental  United  States 
will  soon  exceed  100,000 ! 

The  present  work  is  primarily  intended  to  facilitate  the  statistical 
study  of  the  cancer  problem  throughout  the  world.  On  account  of  the 
exceptional  facilities  for  statistical  inquiry  available  through  the  library 
of  The  Prudential  and  the  hearty  cooperation  of  oflScials  of  the  Federal 
Government,  the  several  states  and  many  foreign  countries,  a  large 
amount  of  entirely  new  information  is  made  conveniently  accessible 
to  the  student  of  the  cancer  problem,  to  the  medical  profession  and  to 
the  general  public.  The  main  results  of  the  investigation  may  be 
summed  up  in  the  brief  but  extremely  suggestive  statement  that  the 
actual  frequency  of  malignant  disease  throughout  the  civilized  world  has 
been  ascertained  to  be  much  more  of  a  menace  to  the  ivelfare  of  mankind 
than  has  generally  been  assumed  to  be  the  case,  and  thai  in  contrast  to  a 
marked  decline  in  the  general  death  rate,  cancer  remains  one  of  the  few 
diseases  actually  and  'persistently  on  the  increase  in  practically  all  of  the 
countries  and  large  cities  for  which  trustworthy  data  are  obtainable. 

In  a  work  of  this  kind  minor  errors  are,  naturally,  not  entirely  avoid- 
able, but  a  special  effort  has  been  made  to  reduce  the  chances  of  clerical 
mistakes  to  a  minimum  by  several  thorough  and  independent  revisions 
of  the  numerous  statistical  tables  appended  to  the  text.  Wherever 
practicable  the  source  of  the  information  used  is  indicated,  and  full 
credit  has  been  given  to  authors  quoted  or  consulted,  aside  from  a  fairly 
complete  bibliography,  limited  to  works  actually  made  use  of,  nearly  all 
of  which  are  in  the  library  of  The  Prudential.  It  would  be  quite  impos- 
sible to  make  mention  by  name  of  all  the  many  correspondents  through- 
out the  world,  government  officials,  officers  of  life  insurance  companies, 
and  others,  who  have  most  courteously  and  considerately  rendered 


PREFACE 

valuable  aid  and  without  whose  aid  the  results  of  this  investigation 
would  have  been  materially  diminished  in  practical  utility.  Among 
those,  however,  who  have  rendered  exceptionally  useful  personal  assis- 
tance, mention  should  be  made  of  Lieutenant-Colonel  C.  E.  McCul- 
loch,  Jr.,  Librarian  of  the  Surgeon-General's  Library,  Dr.  Cressy  L. 
Wilbur,  former  Chief  Statistician  for  Vital  Statistics  of  the  United 
States  Census,  and  Mr.  R.  C.  Lappin,  the  acting  chief  of  that  office, 
Dr.  Joseph  C.  Bloodgood,  Dr.  Thomas  S.  CuUen,  Dr.  James  Ewing,  Dr. 
H,  R.  Gaylord,  Dr.  Edward  J.  Ill,  Dr.  William  L.  Rodman,  Dr.  Harry 
M.  Sherman,  Dr.  J.  H.  Wainwright,  Dr.  Francis  Carter  Wood  and  Dr. 
W.  A.  Jaquith,  Medical  Director  of  The  Prudential. 

All  of  the  statistical  tabulations  and  supplementary  calculations  have 
been  made  in  our  office  under  my  immediate  direction  and  supervision; 
but  efficient  and  valuable  assistance  has  been  rendered  by  Mr.  Frederick  S. 
Crum,  Ph.  D.,  Assistant  Statistician  of  The  Prudential,  who  has  carefully 
revised  the  entire  proof,  and  provided  a  complete  index,  by  authors  and 
subjects.  Among  the  clerks  deserving  of  mention  are  IMr.  Roy  F.  Ed- 
wards, who  has  revised  and  corrected  the  statistical  tables  for  the  United 
States  and  its  subdivisions,  Mr.  Knud  Stoumann,  wlio  has  had  entire 
charge  of  the  foreign  tables,  Mr.  Thomas  J.  Garvey,  who  has  made  the 
final  general  revision  of  rates  and  ratios,  and  Mr.  Edwin  E.  A.  Fisher, 
who  has  drawn  the  twenty-one  charts  illustrating  the  salient  facts  of 
the  cancer  problem.  The  bibliography  is  largely  the  work  of  Miss 
Adelaide  S.  Rinck.  The  printing  of  the  work  by  the  Prudential  Press 
has  involved  many  technical  problems  and  an  unusual  demand  for 
painstaking  attention  to  minute  details  in  the  corrections  and  final 
proofreading  of  the  text  and  tables.  These  difficulties  were  successfully 
overcome  through  the  efficient  assistance  and  hearty  cooperation  of 
Messrs.  J.  W.  McLaughlin,  C.  E.  Lund  and  J.  J.  Macbride,  of  our 
Printing  Department.  The  artistic  design  of  the  charts  is  the  work 
of  INIr.  Edwin  S.  Fancher. 

The  work  is  divided  into  nine  chapters,  to  all  but  one  of  which  there  is 
an  appendix  of  forms  or  tables,  which,  as  a  matter  of  convenience,  have 
been  placed  together  at  the  end  of  the  volume.  Chapter  I,  on  The 
Statistical  Method  in  Medicine,  is  amplified  by  an  appendix  of  the 
principal  cancer  classifications,  past  and  present,  used  in  standard  text- 
books and  in  the  compilation  of  international  cancer  mortality  statistics. 
This  appendix  also  includes  a  useful  classification  of  accessible,  inaccessi- 
ble and  intermediate  malignant  tumors,  as  recommended  by  the  Im- 
perial Cancer  Research  Fund.  Chapter  II,  on  The  Statistical  Basis  of 
Cancer  Research,  is  a  brief  discussion  of  the  fundamental  statistical  facts 
available  for  analysis,  enlarged  by  an  appendix  of  the  blanks  and  certifi- 
cates used  in  connection  with  cancer  mortality  investigations  and  special 
research,  including  the  question  form  for  cancer  census  purposes  recom- 
mended by  the  International  Association  and  the  special  blanks  for 
supplementary  inquiries  into  the  facts  and  circumstances  connected  with 
the  occurrence  of  cancer  of  the  uterus,  mammary  cancer,  gastric  cancer 
and  cancer  of  the  buccal  cavity,  adopted  and  recommended  by  the  Statis- 
tical Committee  of  the  American  Society  for  the  Control  of  Cancer,  in 
cooperation  with  the  General  jNIemorial  Hospital  of  the  City  of  New 


PREFACE 

York.  Chapter  III,  on  The  Increase  in  Cancer,  is  an  extended  discus- 
sion of  the  general  problem  of  the  observed  upward  tendency  of  the  can- 
cer death  rate  throughout  the  world.  The  required  statistical  evidence 
in  support  of  the  conclusion  that  cancer  is  actually  and  not  only  appar- 
ently on  the  increase  is,  however,  included  in  the  appendices  to  the 
several  chapters  on  the  geographical  incidence  of  cancer  in  the  United 
States  and  foreign  countries.  The  Mortality  from  Cancer  in  Different 
Occupations  is  discussed  in  Chapter  IV,  with  an  appendix  of  eight 
tables  of  the  mortality  from  cancer  in  selected  industries  and  employ- 
ments, derived  from  the  decennial  reports  of  the  Registrar-General 
of  England  and  Wales,  but  rearranged  and  recalculated  for  the  present 
purpose.  In  addition,  the  appendix  includes  cancer  mortality  data 
by  occupations,  derived  from  the  Industrial  mortality  experience 
of  The  Prudential  and  the  cancer  census  of  Hungary.  Chapter  V 
presents  an  extended  discussion  of  Cancer  as  a  Problem  in  Life  Insurance 
Medicine,  historically  and  practically  considered,  with  an  appendix  of 
121  tables,  including  a  concise  and  uniform  presentation  of  the 
general  cancer  experience  data  of  a  large  number  of  American  and 
foreign  life  insurance  companies  and  the  collective  results  of  the  Medico- 
Actuarial  Mortality  Investigation.  Chapter  VI,  on  The  Geographical 
Incidence  of  Cancer  Throughout  the  World,  brings  out  forcibly  the  wide 
range  in  the  cancer  frequency  rates  of  different  countries  and  cities  with 
widely  varying  circumstances  of  race,  climate,  habits,  etc.,  all  of  which 
are  shown  to  have  an  important  bearing  upon  the  cancer  problem  as  a 
whole.  Included  in  this  chapter  are  the  results  of  a  special  analysis  of 
the  data  collected  by  the  New  York  State  Institute  for  the  Study  of 
Malignant  Disease  concerning  the  primary  seat  of  growth,  probable 
cause,  the  personal  and  family  history,  etc.  The  information  is  made 
available  for  the  first  time  through  the  courtesy  of  the  Director  of  the 
Institute,  who  placed  the  original  material  at  our  disposition  for  tabula- 
tion and  analysis.  The  principal  tables  of  the  appendix  to  this  chapter 
show  the  facts  of  cancer  mortality  according  to  latitude,  size  of  cities  and 
the  local  rates  of  incidence  by  organs  and  parts  of  the  body  for  thirteen 
representative  countries  throughout  the  world.  In  Chapter  VII,  on  The 
Statistical  Data  of  Cancer  Frequency  in  American  States  and  Cities, 
the  rate  of  cancer  occurrence  throughout  the  United  States  is  discussed 
at  some  length,  and  amplified  by  an  appendix  of  259  tables  of  cancer 
mortality  for  the  registration  area  and  for  the  several  states  and 
cities  in  a  uniform  manner  and  with  a  due  regard,  as  far  as  practicable, 
to  the  elements  of  age,  sex,  race,  organs  and  parts,  etc.  Chapter  VIII 
presents  the  corresponding  information  on  The  Statistical  Data  of 
Cancer  Frequency  in  Foreign  Countries,  with  an  appendix  of  389 
tables  for  countries  other  than  the  United  States,  Chapter  IX 
concludes  the  results  of  the  statistical  inquiry  with  Some  General 
Observations  and  Conclusions  on  the  Cancer  Problem.  This  is  a 
general  discussion  of  practically  all  the  more  or  less  controversial  aspects 
of  the  cancer  question,  with  a  first  regard,  however,  to  sociological, 
anthropological  and  general  scientific  consideration.  The  observations 
are  included  as  a  matter  of  convenience  to  aid  those  who  wish  to  make 
practical  use  of  the  statistical  information,  and  they  are  not  to  be 


PREFACE 

construed  as  a  final  expression  of  qualified  medical  opinion  regarding  any 
or  all  of  the  controversial  aspects  of  the  world-wide  quest  for  the  whole 
truth  of  the  cancer  problem.  The  appendix  to  this  chapter  includes 
reprints  of  suggestive  educational  circulars  used  in  connection  with  the 
nation-wide  propaganda  for  cancer  control  under  the  auspices  of  the 
American  Society  for  the  Control  of  Cancer,  etc. 

The  cancer  question  is  as  old  as  the  history  of  medicine,  and  the 
literature  of  oncology  in  all  its  branches  is  enormous.  Regardless,  how- 
ever, of  all  that  has  been  written  and  said  upon  the  subject,  there  can 
never  come  a  time  when  the  field  of  statistical  inquiry  will  be  exhausted. 
Verifiable  progress  in  the  direction  of  health  and  longevity  requires  the 
use  of  the  statistical  method,  impartially  applied  to  the  subject  under 
consideration.  Cancer  is  apparently  the  most  involved  and  practically 
difficult  problem  in  the  entire  science  and  art  of  medicine  and  surgery. 
An  army  of  men  of  the  highest  order  of  intelligence  have  been  at  work 
for  many  years  in  quest  of  the  cancer  cause  and  a  cancer  cure.  Statistics, 
it  is  true,  is  but  an  auxiliary  science,  but  it  is  one  of  great  promise  in  the 
furtherance  of  medical  research;  for,  after  all,  the  study  of  collective 
phenomena,  regardless  of  innumerable  possibilities  of  error  or  false 
conclusions,  provides  the  only  trustworthy  means  of  determining  with 
approximate  accuracy  the  existing  amount  of  disease  and  the  apparent 
tendency  towards  improvement  or  deterioration,  as  the  case  may  be. 
It  is  readily  to  be  conceded  that  the  data  are  often  faulty  or  incomplete, 
but  this  is  not  a  fatal  objection.  The  betterment  of  our  vital  statistics 
requires  the  cooperation  of  the  medical  profession,  life  insurance  com- 
panies, public  health  officials  and  all  others  directly  or  indirectly 
interested  in  the  prolongation  of  life  and  the  prevention  of  disease.  In 
proportion  as  the  practical  utility  of  vital  statistics  is  better  understood 
and  more  generally  appreciated,  the  required  perfection  of  fundamental 
mortality  data  will  be  brought  nearer  to  the  attainable  ideal. 

The  results  of  the  present  investigation  emphatically  prove  the  im- 
perative need  of  uniformity  in  the  rules  of  statistical  practice  and  the 
adoption  of  standard  forms  and  blanks  for  cancer  inquiries.  The  main 
shortcomings  of  the  investigation  are  attributable  to  the  want  of  uni- 
formity in  methods  of  classification  and  the  more  or  less  abbreviated 
presentation  of  the  original  facts  provided  by  the  death  certificate.  It  is 
sincerely  to  be  hoped  that  the  results,  inadequate  as  they  are,  will  suggest 
the  necessity  for  an  international  agreement  regarding  general  con- 
formity to  the  best  methods  at  present  in  use.  Such  an  improvement  can 
be  brought  about  only  by  the  cooperation  of  all  who  are  directly  and  im- 
partially interested  in  cancer  study  and  cancer  research.  Until  the 
ideal  is  attained  and  uniform  methods  of  classification  and  completeness 
of  records  are  secured  for  all  the  countries  of  the  civilized  world,  the 
present  work  will  at  least  serve  the  purpose  of  having  made  the  existing 
statistical  facts  of  cancer  frequency  available  in  a  convenient  form.  In 
its  final  analysis,  the  essential  requirement  is  not  the  absolute  truth,  but 
the  approximate  or  relative  truth.  For  all  practical  purposes  the  latter 
is  fully  sufficient,  and  serves  as  a  safe  and  satisfactory  guide  in  all  the 
ordinary  affairs  of  life.  Conceding  frankly  the  inherent  defects  and 
shortcomings  of  existing  statistical  data  and  present-day  methods  of 


PREFACE 

statistical  tabulation  and  analysis,  it  would  seem  to  be  an  entirely  safe 
assumption  that,  in  the  main,  the  general  conclusions  based  upon  the 
available  statistics  of  human  mortality  throughout  the  world  are  ap- 
proximately correct  and  trustworthy  in  the  advancement  of  the  aims  and 
ideals  of  a  world-wide  associate  effort  at  the  prolongation  of  life  and  the 
prevention  of  disease.  It  is  therefore  to  be  hoped  that  the  present  work 
may  render  substantial  assistance  toward  the  attainment  of  this  purpose, 
that  it  may  lighten  the  labor  of  those  in  need  of  statistical  data  re- 
quired in  other  lines  of  specialized  cancer  research,  that  it  may  emphasize 
concretely  and  conclusively  the  truly  tremendous  social  and  economic 
importance  of  malignant  disease  as  a  cause  of  death  in  adult  life,  and 
that  it  may  accelerate  the  effort  to  disseminate  the  whole  truth  regarding 
this  insidious  afHiction  among  the  general  public  and  emphasize  the 
supreme  necessity  for  early  diagnosis  and  early  qualified  medical  or 
surgical  treatment.  If  the  investigation  contributes  measurably  towards 
the  realization  of  these  aims  and  ideals,  the  results,  though  at  first  quite 
general  in  their  nature,  must  ultimately  react  favorably  upon  the  vast 
business  of  life  insurance  companies,  which  are  primarily  and  preemi- 
nently interested,  on  behalf  of  their  policyholders,  in  any  and  all  measures 
aiming  at  the  deliberate  prevention  and  control  of  disease  and  the 
highest  attainable  average  duration  of  human  life. 

F.  L.  H. 


Newark,  N.  J.,  May  2,  1915. 


TABLE  OF  CONTENTS 

Chapter   I  page 

The  Statistical  Method  in  Medicine 1 

Sources  of  Statistics — Principles  of  Analysis — Terminology — Difficulties  of 
Diagnosis — Early  History — Past  and  Present  Methods  of  Classification — 
Natural  History  of  Cancer — Standardized  Death  Rates — Function  of  Age  and 
Senility — Ethnic  Factors — Question  of  Cancer  Increase — Death  Certification 
and  Classification. 

Chapter   II 

The  Statistical  Basis  of  Cancer  Research 21 

Limitations  of  Statistical  Analysis — Difficulties  of  Precise  Classification — Early 
Observations  on  Cancer  Statistics — Need  of  an  Exhaustive  Study — Uniform 
Methods  of  Tabulation  and  Analysis — ^Recognition  of  Cancer — Lnportance 
of  Microscopical  Research. 

Chapter  III 

The  Increase  in  Cancer 28 

Early  Mortality  from  Cancer  in  London — Causes  of  Local  Variations — Argu- 
ment by  King  and  Newsholme — Statistics  of  Frankfurt  a/M. — Increase  in 
Cancer  by  Organs  and  Parts — Utility  of  a  Cancer  Census — Cancer  among 
Primitive  Races — Statistical  Problems  of  Erroneous  Diagnosis — Evidence  of 
Cancer  Increase  throughout  the  World — Misleading  Statistical  Observations 
— Useless  Controversies — Trustworthiness  of  American  MortaHty  Statistics — 
Contributory  Causes  of  Death  in  Cancer — Continued  Increase  ia  Cancer 
Frequency — Pubhc  Menace  of  Ignorance  and  Indifference, 

Chapter   IV 

Mortality  from  Cancer  in  Different  Occupations 48 

Review  of  the  Literature  on  Cancer  in  Relation  to  Occupation — Cancer  in  the 
Patent-fuel  Industry — Pitch  Ulceration  and  Paraffin  Cancer — Occupational 
Incidence — Alcoholism — Prisons  and  Asylums — Petroleum  Industry — Malig- 
nant Disease  of  the  Lungs  in  JVIiners — Gardening  and  Agriculture — Cancer 
among  Paraffin-workers — Brewers — Furriers  and  Skinners — Seamen — Tia- 
plate-workers — Lead-workers — Rubber-workers — Chemical-workers — X-ray 
Workers — Cancer  and  Exposure  to  Light — Cancer  in  the  Synthetic-dye 
Industry — Occupational  MortaHty  Statistics — Life  Insurance  Experience — 
Foreign  Statistical  Investigations — Requirements  of  Scientific  Statistical 
Research. 

Chapter   V 

Cancer  as  a  Problem  in  Life  Insurance  Medicine 77 

Cancer  in  the  Literature  of  Life  Insurance  Medicine — Early  Life  Insurance 
Experience  Data — Discussion  of  Scottish  Widows'  Fund  Experience — 
Observations  Regarding  Cancer  Increase — ^Experience  of  American  Life  Insur- 


CONTENTS 

PAGE 

ance  Companies — German  and  Austrian  Insurance  Experience — Medico- 
Actuarial  Investigation — Family  History — Effect  of  Build  and  Conjugal  Con- 
dition— Cancer  of  Breast  and  Generative  Organs  among  Single  and  Married 
Women — Experience  of  The  Prudential  Insurance  Company  of  America — 
Cancer  as  a  Life  Insurance  Problem. 

Chapter   VI 

The  Geographical  Incidence  of  Cancer  Throughout  the  World ....    104 

Problems  of  Geographical  Pathologj' — Recent  International  Statistics — Cancer 
Frequency  throughout  the  World — Distribution  of  Cancer  in  the  United 
States — Local  Variations  in  Cancer  Occurrence — Mortality  from  Biliary 
Calculi  and  Tumors  of  the  Uterus  and  Ovaries — Increase  in  Cancer,  by  Organs 
and  Parts,  and  by  Age  and  Sex — -MortaUty  by  Season — Statistics  of  the  New 
York  State  Pathological  Institute — Pre\'ious  Duration  of  Malignant  Disease — 
Family  History  and  Heredity — Primary  Seat  of  Growth,  Probable  Causes,  and 
Personal  Historj' — Geographical  Pathology  of  Cancer  by  Specified  Organs 
and  Parts,  throughout  the  World. 

Chapter   VII 

The  Statistical  Data  of  Cancer  Frequency  in  American  States  and 

Cities 126 

Limitations  of  Crude  Statistics — Progressive  Increase  in  the  Cancer  Death 
Rate — Mortality  in  Large  American  Cities — Sources  of  Errors — Range  in 
Cancer  Death  Rates — Comparative  Mortality  Rates  by  Organs  and  Parts — 
Comparative  Mortality  Rates  by  Age,  Sex  and  Race — Cancer  among  Mexicans. 

Chapter   VIII 

The  Statistical  Data  of  Cancer  Frequency  in  Foreign  Countries .  .    133 
Comparative  Cancer  Mortality  Rates  for  Europe — Africa — Asia — Australasia — 
Western    Hemisphere — Limitations    of    International    Statistics — Cancer   a 
World-\N-ide  Menace — Effect  of  Latitude  and  Longitude,  and  of  Size  of  Cities 
— Comparative  Death  Rates  of  American  and  European  Cities. 

Chapter   IX 
Some  General  Observations  and  Conclusions  on  the  Cancer  Problem  146 

Cancer  among  Primitive  Races — Cancer  among  the  Jews — North  American 
Indians — Gypsies — Determinable  Factors  of  Cancer  Frequency — Age  and 
SeniHty — Physical  Condition — Growth  and  Development — Precancerous 
Lesions — Gastric  Ulcers  and  Gall-stones — Uterine  Cancer — Early  Diagnosis 
— Hospital  Statistics — PubUc  Institutions — Soldiers'  Homes — Surgical 
Aspects — Problem  of  Recurrence — Duration  of  Disease — Degree  of  Ma- 
lignancj — Clinical  Signs — Anaemia — Prognosis — Heredity — Overnutrition — 
Metabolic  Disorders — Vegetarianism — Diet — Civilization — Theory  of  Atra 
Bills — Biochemical  Aspects — Goitre — Thyroid  Carcinoma — Obesity — Alcohol 
— Smoking — Gall-stones  and  Chronic  Irritation — Tuberculosis — Sj^jhilis — 
Rheumatism  —  Gout — Diabetes  —  Appendicitis — Parasitic  Theory  —  Cancer 
Houses  and  Villages — Cancer  a  Deux  or  Marital  Infection — Surgical  Infection 
— Worry — Insanity — Need  of  Educational  Campaign  in  Methods  of  Control 
— Restatement  of  Conclusions  and  Results. 


CONTENTS 


L/HARTS  PAGE 

1  International  Statistics  of  Cancer  Mortality,  1908-1912 224 

2  Comparative  Cancer  Mortality  in  American  and  Foreign  Cities  22G 

3  International  Cancer  Mortality  by  Organs  and  Parts 228 

4  Cancer  Mortality  by  Age  and  Organs  or  Parts,   1903-1912, 

United  States  Registration  Area 230 

5  Cancer  Mortality  by  Sex  and  Age,  1901  and  1911,  United  States 

Registration  States  of  1900 232 

6  Comparative  Cancer  Mortality  of  Southern  Cities,  by  Race  .  .  .  234 

7  Cancer  Mortality  of  Maryland,  by  Race 236 

8  "               "               United  States  Registration  Area 238 

9  "               "               England  and  Wales 240 

10  "               "               Ireland 242 

11  "              "              Holland 244 

12  "              "              Bavaria 246 

13  "               "               Switzerland 248 

14  "              "              Italy 250 

15  "              "              Japan 252 

16  "              "              Australia 254 

17  "              "              Uruguay 256 

18  "              "              New  York  City 258 

19  "              "              London 260 

20  "              "              Prudential  Industrial  Experience 262 

21  Cancer  Fatality  Rate,  The  Johns  Hopkins  Hospital 264 


Appendices 

A     Tumor  Classifications 267 

B     Cancer  Records,  Inquiry  Blanks  and  Forms 284 

C     Mortality  from  Cancer  in  Different  Occupations 305 

D    Cancer  Mortality  Statistics  of  Life  Insurance  Companies 316 

E     International  Cancer  Mortality  by  Latitude,  Size  of  Cities  and 

Specified  Organs  and  Parts 402 

F     Part    I — Cancer  Statistics  of  the  United  States  Reg.  Area.  .  .  .  418 

Part  II — Cancer  Statistics,  States  and  Cities  of  United  States .  .  450 

G     Cancer  Statistics  of  Foreign  Countries 582 

H     Recommendations  and  Instructions  on  the  Control  of  Cancer  776 

Bibliography 787 

Index  of  Authors 807 

Index  of  Subjects 811 


A  STATISTICAL  SURVEY  OF  THE  MORTALITY  FROM 
CANCER  THROUGHOUT  THE  WORLD 

CHAPTER  I 
THE  STATISTICAL  METHOD  IN  MEDICINE 

Sources  of  Statistics — ^Principles  of  Analysis — Terminology — ^Difficulties  of  Diagnosis — 
Early  History — Past  and  Present  Methods  of  Classification — Natural  History  of  Can- 
cer— Standardized  Death  Rates — ^Function  of  Age  and  SeniHty — Ethnic  Factors — 
Question  of  Cancer  Increase — Death  Certification  and  Classification. 

Within  the  vast  range  of  collective  phenomena  there  are  few  more  in- 
teresting subjects  for  statistical  analysis  than  cancer,  or  what  is,  perhaps, 
more  appropriately  termed  the  science  of  ojicology,  which  comprehends 
tumors  of  all  kinds,  whether  malignant  or  benign  or  ill-defined.  The 
mortality  from  tumors  has  at  all  times  attracted  considerable  attention, 
and  even  some  of  the  earliest  contributions  to  the  scientific  study  of 
cancer  include  statistical  observations  derived  from  general  mortality 
or  hospital  records.  If  the  mortahty  from  cancer  were  a  constant 
quantity,  it  would  be  a  foregone  conclusion  that  the  ascertainment  of 
the  underlying  causes  or  conditioning  circumstances  of  cancer  frequency 
would  defy  analysis.  Since  the  cancer  death  rate  throughout  the  world 
is  subject  to  a  very  considerable  variation,  it  is  equally  obvious  that 
the  underlying  causes  or  conditioning  circumstances  must  vary  to  an 
equal  degree,  and  therefore  come  within  the  range  at  first  of  scientific 
conjecture  and  at  last  of  scientific  conclusiveness.  It  is  for  these 
reasons  that  the  statistical  method  in  medicine  has  been  of  such 
exceptionally  practical  value  when  applied  with  skill  and  impartiality 
to  the  study  of  questions  unusually  involved  because  of  the  innumerable 
factors  u'nderlying  observed  phenomena  more  or  less  indefinitely 
termed  disease  and  death.  Statistics  is  chiefly  an  auxiliary  method  in 
connection  with  scientific  inquiries;  but  it  is  none  the  less  necessary  to 
caution  the  inexperienced  against  the  use  of  a  method  or  science  which 
on  its  own  account  requires  as  much  study  and  consideration,  and  as 
much  practical  experience,  as  medicine  or  surgery  or  both  com- 
bined. The  liability  to  error  in  the  correct  interpretation  of  collective 
phenomena  subjected  to  critical  analysis  is  fully  as  great  as  the  chances 
of  mistakes  in  medical  or  surgical  diagnosis.  The  practical  value  of 
the  statistical  method  in  medicine,  however,  is  now  fully  recognized  by 
the  foremost  authorities  on  medicine,  surgery,  biology  and  public 
health  and  the  method  has  the  sanction  of  many  years  of  extensive 
teaching  experience.  The  use  of  statistical  data  in  the  consideration 
of  medical  and  sanitary  problems  has  therefore  become  practically  in- 
dispensable. The  broadening  sphere  of  medicine,  which  now  includes 
a  vast  system  of  public  health  administration  and  the  medical  education 
of  the  general  public  in  matters  of  personal  hygiene,  more  than  ever 
suggests  the  importance  of  extreme  care  and  caution  in  the  use  of  the 
statistical  method,  which  alone,  however,  provides  the  means  of  arriving 


THE  MORTALITY  FROM  CANCER 

at  approximately  accurate  conclusions  regarding  the  relative  degree 
of  frequency  of  different  diseases  and  the  apparent  tendency  of  particular 
diseases  to  increase  or  diminish,  in  proportion  to  the  population  afifected. 

Difficulties  of  Statistical  Research 
The  statistical  study  of  cancer  involves  exceptionally  difficult  technical 
considerations,  which  arise  largely  out  of  the  complex  nature  of  the  cancer 
problem,  biologically,  pathologically,  medically  or  surgically  considered. 
The  literature  of  cancer  statistics  is  quite  considerable,  but  largely  con- 
troversial, and  much  of  it  is  decidedly  superficial  and  misleading. 
Statistical  fallacies  in  cancer  discussions  are  so  common  that  the  required 
statistical  treatment  of  the  subject  has  been  much  impaired  in  value,  with 
a  world-wide  loss  of  confidence  in  the  results.  Progress,  however,  is  being 
made  in  the  direction  of  a  more  rational  and  trustworthy  treatment  of 
cancer  facts  and  in  the  necessarily  concise  presentation  of  the  data  with 
at  least  an  approach  to  uniformity,  based  on  standardized  methods  of 
original  inquiry.  The  statistical  material  of  cancer  mortality  for  the 
civilized  countries  of  the  world  is,  however,  so  enormous  that  a  complete 
analysis  of  all  the  facts  is  quite  impossible.  The  gradually  expanding 
registration  area  of  the  world  provides  an  increasing  amount  of  statis- 
tical material,  and  more  qualified  consideration  is  being  given  to  the 
elementary  conditioning  factors,  such  as  age,  sex,  race,  etc.  For 
many  countries  no  information  regarding  the  incidence  of  cancer  by 
organs  or  parts  of  the  body  affected  is  as  yet  available;  but  this  defect 
is  also  gradually  being  corrected.  The  inherent  hmitations  of  all  can- 
cer mortality  data  are  being  better  appreciated  on  the  part  of  the 
medical  profession,  government  officials  and  the  general  pubHc,  so  that 
the  increasing  volume  of  statistical  information  is  also  improving  in 
quality  and  is  therefore  becoming  more  useful  in  the  world-wide  quest 
for  the  whole  truth  of  the  cancer  problem. 

Sources  of  Cancer  Mortality  Statistics 
All  cancer  mortality  statistics  for  the  general  population  are  derived 
from  official  mortality  records  or  death  certificates  originally  filled  out 
by  the  attending  physician  or  some  person  assumed  to  be  familiar  with 
the  facts  as  regards  the  cause  of  death.*  In  the  absence  of  compulsory 
medical  attendance  it  is  obvious  that  such  records  must  vary  in  accord- 
ance with  the  perfection  of  death  certification,  and  it  is  self-evident 
that  the  returns  for  countries  in  which  a  medical  certificate  as  regards 
the  cause  of  death  is  not  required  must  be  of  very  limited  intrinsic  value. 
For  most  of  the  civilized  countries  this  requirement  is  met  to  a  reason- 
ably satisfactory  degree,  and  what  has  been  said  by  Longstaff  with 
reference  to  the  value  of  death  certification  in  England  appHes  to  most 
of  the  other  large  civilized  countries  for  which  the  cancer  mortality 
data  are  available  for  a  period  of  years.  In  his  "Studies  in  Statistics," 
in  connection  with  a  critical  study  of  the  national  system  of  vital 
statistics,  George  B.  Longstaff  observes 

I  am  thoroughly  convinced  of  the  soundness  of  that  system  and  the  fallacies  inherent 
in  all  attacks  upon  it.  Moreover,  having  studied  for  several  years  the  figures  relating  to 
"Alleged  Causes  of  Death,"  I  have  been  more  and  more  convinced  of  the  value  of  those 

•The  sources  of  cancer  mortality  statistics  are  fully  discussed  in  Chapter  II. 


STATISTICAL  METHOD  IN  MEDICINE 

figures,  and  I  fully  believe  that  they  may  be  taken  as,  on  the  whole,  a  fair  approximation 
to  the  truth.  At  the  same  time  it  is  hardly  necessary  to  say  that,  like  all  other  statistics, 
they  require  care  and  knowledge  in  handling.  Without  doubt  the  figures  relating  to 
alcoholism,  venereal  diseases,  and  perhaps  insanity,  are  almost  valueless;  but  that  does  not 
prove  that  those  relating  to  scarlet  fever,  pneumonia,  or  cancer  are  equally  valueless. 
Neither  does  the  fact  that  a  large  number  of  certificates  are  carelessly  filled  up  invalidate 
the  far  larger  number  that  are  more  trustworthy:  indeed,  these  very  sources  of  error  are 
subject  to  laws,  and  are  more  or  less  constant  factors  of  the  whole.  When  it  is  possible, 
as  I  have  elsewhere  proved  it  to  be,  to  find  general  laws  regulating  many  of  the  causes 
of  death,  and  especially  mutual  relations  between  these  causes,  and  relations  between 
some  of  them  and  various  external  phenomena,  the  only  possible  inference  that  I  can 
deduce  is  that  the  figures  dealt  with  are  the  expression,  more  or  less  accurate,  of  facts  in 
nature. 

This  conclusion  does  not  in  the  least  minimize  the  serious  risk  of  error 
in  the  careless  or  superficial  use  of  the  data  of  mortality  statistics, 
irrespective  of  the  diseases  dealt  with ;  for,  as  pointed  out  by  Longstajff 
on  the  same  occasion,  "there  are  numerous  fallacies  to  which  the  classifi- 
cation of  deaths  according  to  their  alleged  causes  is  liable."  And  he 
enumerates  particularly  the  more  or  less  varying  proportions  of  ill- 
defined  deaths,  the  more  or  less  varying  proportions  of  indefinite  causes, 
the  deliberate  falsification  of  returns  for  personal  or  family  reasons,*  and 
the  effect  of  the  progress  of  medical  science,  improved  diagnosis,  etc. 
All  of  these  reasons  notwithstanding,  the  conclusion  appears  to  be  in- 
controvertible that  on  the  whole  the  present  system  of  death  registration 
is  entitled  to  confidence  and  that  the  results  approximately  represent 
the  true  state  of  the  nation's  health. f 

Fundamental  Principles  of  Statistical  Analysis 
The  fundamental  principle  of  all  statistical  inquiries  is  the  law  of 
large  numbers.  The  accuracy  of  the  statistical  judgment  is  in  propor- 
tion to  the  mass  of  the  material  considered  and  the  thoroughness  of  the 
methods  of  analysis  in  matters  of  detail.  The  law  of  large  numbers  is 
defined  in  the  statement  that  "in  a  large  number  the  actual  relations  are 
more  accurately  expressed  than  in  a  small  number,"  and  hence  the 
probability  may  be  concluded  much  more  safely  from  a  large  number 
of  observations.  The  exceptional  cases  are  obliterated  in  the  large 
number,  which  approaches  more  closely  to  the  truth,  and  as  such  re- 
quires to  be  accepted  as  approximately  conclusive. 

In  conformity  to  this  principle  the  statistical  investigation  of  cancer 
should  be  on  as  broad  a  scale  as  possible,  with  a  due  regard,  of  course, 
to  the  quality  of  the  facts  as  well  as  to  their  quantity.  For  reasons 
which  do  not  require  discussion,  the  application  of  mathematical  methods 
to  the  cancer  problem  is  decidedly  less  desirable  than  the  use  of  impar- 
tially collected  statistical  data  derived  from  a  large  area  of  observa- 
tions, extensive  in  point  of  time.  J 

•This  aspect  of  the  cancer  problem  is  of  considerable  practical  importance.  I  have  briefly  discussed  the 
subject  in  an  address  on  "The  Accuracy  of  American  Cancer  Mortality  Statistics,"  read  before  the  American 
Public  Health  Association,  Jacksonville,  1914. 

tSee  also  in  this  connection  the  correspondence  between  Dr.  Bashford  and  myself  in  the  London  Lancet,  Feb- 
ruary 7  and  April  11,  1914. 

JThe  principal  works  of  reference  in  support  of  this  point  of  view  are  "Letters  on  the  Theory  of  Prob- 
abilities," N.  A.  Quetelet,  London,  1849;  "Essays  and  Papers  on  Some  Fallacies  of  Statistics  concerning  Life 
and  Death,  Health  and  Disease,"  Henry  W.  Rumsey,  London,  1875;  "History,  Theory  and  Technique  of 
Statistics,"  August  Meitzen,  Philadelphia,  1891;  "Studies  in  Statistics,"  Geo.  B.  Longstaff,  London,  1891; 
and  "Essay  on  Collective  Phenomena  and  the  Scientific  Value  of  Statistical  Data,"  E.  G.  F.  Gryzanovski, 
American  Economic  Association,   1906.       Important  references  to  errors  and  defects  in   vital  statistics 

3 


THE  MORTALITY  FROM  CANCER 

Difficulties  of  Cancer  Terminology 

Since  the  term  "cancer"  does  not  permit  of  an  absolutely  scientific 
definition,  it  is  obvious  that  the  statistical  consideration  of  the  data 
derived  from  different,  though  official,  sources  can  not  be  made  to  con- 
form to  the  most  rigid  demands  of  scientific  accuracy.  The  borderland 
of  innocency  or  malignancy  in  tumors  is  large  or  small  according  to  the 
skill  and  experience  of  the  diagnostician.*  The  accuracy  of  the  diagnosis 
itself  is  affected  by  the  seat  of  the  disease  and  the  necessary  oppor- 
tunities for  autopsies  and  subsequent  microscopical  research.  A  scien- 
tific definition  of  the  term  "tumor"  is  by  all  competent  authorities 
admitted  to  be  at  present  impossible.  But  it  is  now  less  difficult  than  in 
former  years  to  exclude  small  swellings  of  numerous  kinds  which  can  not 
properly  be  regarded  as  within  the  tumor  class.  Cancer  is  unquestion- 
ably a  fundamental  disorder  of  postnatal  growth  and  development.  It 
has  properly  been  observed  by  Rudolph  Schmidt  in  his  treatise  on 
"Diagnosis  of  Malignant  Tumors  of  the  Abdominal  Viscera"t  that  "in 
their  ultimate  causes  all  processes  of  growth  are  traced  back  to  and 
become  merged  with  the  problem  of  life  itself."  Regardless  of  a  truly 
enormous  literature,  the  origin,  life  history  and  causation  of  tumors 
remain  obscure;  and  until  further  progress  is  made  in  this  direction  the 
terminology  of  oncology  must  remain  unsatisfactory. 

In  their  work  on  "General  Pathology,"  Pembrey  and  Ritchie  say  that 
"in  the  case  of  true  tumors  the  characteristics  to  be  looked  on  as  com- 
mon to  all  are,  first,  that  there  is  a  progressive  proliferation  of  cells;  and, 
secondly,  that  such  proliferation  does  not  occur  in  response  to  any 
normal  requirement  of  the  tissue  from  which  the  tumor  springs. "{ 

The  characteristics  of  malignant  tumors,  with  which  the  present  dis- 
cussion is  almost  exclusively  concerned,  although  some  attention  will  be 
given  to  tumors  of  the  non-malignant  type,  are  briefly  defined  by  these 
authors  as 

First,  generally  speaking,  their  growth  is  much  more  rapid,  and,  secondly,  in  addition  to 
the  original  focus,  secondary  foci  tend  to  appear  in  other  parts  of  the  body.  In  addition 
to  this,  a  third  outstanding  feature  of  the  malignant  tumor  is  the  fact  that  at  the  periph- 
eral parts  there  is  almost  invariably  an  infiltration  of  the  surrounding  parts  with  ex- 
tensive, fine,  frequently  microscopic  prolongations,  which  make  it  impossible  to  mark 
off  by  any  palpable  characteristic  the  growth  from  the  tissues  in  which  it  lies.^ 

*"It  has  long  been  held  that  some  benign  growths  are  peculiarly  liable  to  undergo  transformation  into  cancer. 
This  view  is  held,  among  others,  by  Sir  James  Paget,  Sir  Jonathan  Hutchinson,  and  Dr.  Max  Borst.  The 
innocent  tumors  which  are  regarded  as  most  likely  to  undergo  this  change  are  sebaceous  adenomata,  moles, 
warts,  and  adenomata  in  general,  but  no  innocent  tumor  seems  to  be  more  likely  to  undergo  cancer  degeneration 
than  the  multiple  polypoid  adenoma  of  the  rectum."  ("The  Disorders  of  Post-Natal  Growth  and  Develop- 
ment," Hastings  Gilford,  London,  1911.) 

t"Diagn»si3  of  the  Malignant  Tumors  of  the  Abdominal  Viscera,"  by  Rudolph  Schmidt;  English  trans- 
lation by  Joseph  Burke,  New  York,   1913. 

t  "Text-book  of  General  Pathology,"  edited  by  Pembrey  and  Ritchie,  London,  New  York,  1913,  p.  224. 

g  "Text-book  of  General  Pathology,"  edited  by  Pembrey  and  Ritchie,  London,  New  York,  1913,  p.  227. 

are  the  following:  "A  Study  of  Three  Thousand  Autopsies,"  Richard  C.  Cabot,  Journal  of  the  American  Med- 
ical Association,  December  28,  1912;  "Past  and  Present  of  the  Autopsy  in  Medical  Education  and  Practice," 
H.  Oertel,  Journal  of  the  American  Medical  Association,  June  7,  1913;  "Statistics  of  Post-mortems  in  Large 
Hospitals  in  the  United  States  a.ndAhToad,"E.lI.LeviBskiCoib'in,Journalof  the  American  Medical  Association, 
June7, 1913;  "Gleanings  from  Calcutta  Post-mortem  Records,"  Leonard  Rogers, /ndio  Medical  Gazette,  1908-14; 
''Some  Diagnostic  Failures,"  H.  B.  Shaw,  British  Medical  Journal,  April  18,  1914;  "An  Experiment  in  the 
Compilation  of  Mortality  Statistics,"  Louis  Dublin,  Quarterly  Publication  American  Statistical  Association, 
December,  1914;  "Inaccuracies  of  American  Mortality  Statistics,"  H.  Oertel,  American  Underwriter,  May,  1913; 
■'Betterment  of  American  Mortality  Statistics,"  E.  B.  Phelps,  American  Underwriter,  March,  1914;  "Common 
Errors  in  Diagnosis,"  Adolphe  Abrahams,  M.  D.,  The  Practitioner,  London,  March,  1915. 

4 


STATISTICAL  METHOD  IN  MEDICINE 

Difficulties  of  Cancer  Diagnosis 
The  practical  difficulties  of  accurate  diagnosis  and  uniform  tumor 
classification  are  best  illustrated  in  the  elaborate  discussion  of  swellings 
in-  the  "Index  of  Differential  Diagnosis,"  edited  by  Herbert  French, 
M,  D.,  and  others.  New  York,  1913.  Even  the  most  experienced  physi- 
cian and  surgeon  must  at  times  be  seriously  in  doubt  as  to  the  true 
nature  of  the  cancerous  processes  first  indicated  by  swellings  which  may 
be  quite  similar,  at  least  in  their  outward  appearance,  to  an  abnormal 
growth  of  a  non-malignant  type.  Fibro-adenoma  of  the  breast,  for 
illustration,  is  a  comparatively  common  form  of  benign  tumor;  but 
there  are  many  pathological  varieties,  including  some  containing  cysts 
and  intro-cystic  growths,  which  may  or  may  not  warrant  being  properly 
classified  as  malignant.  Tumors  of  the  abdominal  viscera,  which 
account  for  so  large  a  proportion  of  the  mortality  from  tumors  of  all  forms, 
are  accurately  diagnosed  only  with  considerable  difficulty,  particularly 
in  the  initial  stages  of  the  disease.  Mechanical  aids,  such  as  the  chem- 
ical evidence  of  blood  in  tjie  feces  or  the  determination  of  vegetable  and 
bacterial  organism  in  the  gastro-intestinal  tract,  have  not  been  found 
of  much  practical  value,  and  this  has  been  true  also  of  radiological 
examinations,  the  ultimate  diagnosis  being  in  most  cases  the  sum  total 
of  clinical  findings  by  different  and  often  widely  varying  methods. 

Cancer  an  Ancient  Disease 
Malignant  tumors,  however,  diagnosed  with  difficulty  or  classified 
with  uncertainty,  are  among  the  oldest  known  afflictions  of  civilized 
mankind.  The  history  of  cancer  can  be  traced  backwards  by  an  un- 
broken record  to  early  Greece,  and  even  to  still  more  ancient  India  and 
Egypt,  although  the  more  remote  the  records,  the  more  obscure,  naturally, 
the  description  of  the  initial  symptoms  and  pathological  manifestations 
of  the  disease.  Unquestionably  Hippocrates  was  fairly  well  acquainted 
with  cancer  of  the  breast,  and  he  recognized  the  occurrence  of  malig- 
nant disease  in  certain  of  the  internal  organs  as  well.  According  to 
Woglom,  in  his  brief  historical  review  of  malignant  disease  in  the 
"Studies  in  Cancer  and  Allied  Subjects,"  published  by  the  George  Crocker 
Special  Research  Fund,  previous  to  the  time  of  the  Roman  physician 
Celsus,  the  term  "carcinoma"  included  the  most  bizarre  collection  of 
swellings,  distinguishing  cancer  from  carcinoma,  but  including  under  the 
former  heading  many  lesions  which  are  now  recognized  as  simply  inflam- 
matory. Cancer  was  well  known  to  Galen,  one  of  the  ancient  founders  of 
medicine,  and  surgical  operations  on  account  of  cancer  were  practised  by 
Leonidis  (about  180  B.  C),  who  was  the  first  to  appreciate  the  importance 
of  the  retraction  of  the  nipple  as  a  diagnostic  sign  in  cancer  of  the  breast. 
A  review  of  the  literature  of  cancer  during  the  long  intervening  period  of 
time,  which  practically  coincides  with  the  recorded  history  of  mankind, 
would  needlessly  enlarge  the  present  discussion,  which  has  been  made  to 
include  these  brief  medical  observations  for  the  sole  purpose  of  emphasiz- 
ing the  subsequent  conclusion  that,  regardless  of  inherent  defects  in 
death  certification,  the  available  cancer  mortality  returns  may,  on  the 
whole,  be  accepted  with  confidence  as  representing  with  at  least  approxi- 
mate accuracy  the  true  local  incidence  of  the  disease  and  its  varying 


THE  MORTALITY  FROM  CANCER 

degree  of  frequency  within  the  modern  period  of  official  death  regis- 
tration. The  history  of  cancer  from  the  earhest  times  to  the  present 
day  has  been  admirably  brought  together  in  a  work  of  truly  colossal 
magnitude  by  Prof.  Dr.  Jacob  Wolff,  under  the  auspices  of  the  German 
Society  for  Cancer  Research.*  Wolff  gives  emphasis  to  the  historical 
changes  in  the  point  of  view  regarding  the  causation,  pathology  and 
treatment  of  cancer,  from  the  overthrow  of  Galen's  theories  during  the 
sixteenth  and  seventeenth  centuries  to  the  far-reaching  discoveries  of 
Virchow,  in  1853,  and  the  theory  of  Cohnheim,  in  1867,  which  underlie 
modern  conceptions  of  tumor  pathology. 

Place  of  Cancer  in  the  Progress  of  Medicine 
Oncology  as  an  exact  science  on  the  foundations  of  Virchow's  cellular 
pathology  is  of  comparatively  recent  date.  Yet  it  is  probably  true 
that  more  is  now  known  regarding  the  physiology  and  pathology 
of  tumors  than  concerning  any  other  disease,  with  the  possible  excep- 
tion of  tuberculosis.  The  remarkable  progress  in  exact  tumor  diagnosis 
during  recent  years  is  largely  due  to  the  development  of  microscopical 
science  and  the  highly  specialized  efforts  in  modern  laboratory  research. 
Previous  to  the  advent  of  biological  science,  much  of  the  prevailing 
medical  opinion  regarding  tumor  pathology  was  mere  guesswork,  and 
often  seriously  erroneous.  At  the  same  time  even  a  brief  review  of  the 
medical  literature  of  the  last  one  hundred  and  fifty  years  or  more,  con- 
clusively proves  the  soundness  of  prevailing  general  conceptions  regard- 
ing cancerous  processes  and  the  practical  certainty  that  at  least  as 
regards  terminal  diagnosis  the  majority  of  malignant  tumors  were 
accurately  diagnosed  as  such  and  correctly  classified  in  conformity 
to  prevaihng  systems  of  nosology.  For  illustration,  the  observations 
of  Samuel  Sharp  on  encysted  tumors  and  on  the  amputation  of  the 
"cancer'd"  and  scirrhous  breast,  published  in  his  treatise  on  "The  Opera- 
tions of  Surgery,"  issued  in  a  seventh  edition,  London,  1758,  include 
the  following  interesting  and  useful  remarks: 

The  Success  of  this  Operation  is  exceedingly  precarious,  from  the  great  Disposition  there 
is  in  the  Constitution  after  an  Amputation,  to  form  a  new  Cancer  in  the  Wound,  or  some 
other  Part  of  the  Body.  TMien  a  Schirrus  has  admitted  of  a  long  Delay  before  the  Opera- 
tion, the  Patient  seems  to  have  a  better  Prospect  of  Cure  without  danger  of  a  Relapse,  than 
when  it  has  increased  very  fast,  and  with  acute  Pain.  I  cannot  however  be  quite  posi- 
tive in  this  Judgment,  but  upon  looking  around  amongst  those  I  know  who  have  recovered, 
find  the  Observation  so  far  well-grounded.  There  are  some  Surgeons,  so  disheartened  by 
the  Ill-success  of  this  Operation,  that  they  decry  it  in  every  Case,  and  even  recommend 
certain  Death  to  their  Patients,  rather  than  a  Trial,  upon  the  Supposition  it  never  relieves; 
but  the  instances,  where  Life  and  Health  have  been  preserved  by  it,  are  sufficiently  numer- 
ous to  warrant  the  Recommendation  of  it. 

Ulcers  and  Cancerous  Complaints 

Bell's  treatise  on  "Ulcer,"  published  in  1784,  and  Pearson's  "Observa- 
tions on  Cancerous  Complaints,"  published  in  1793,  make  now  rather 
curious  reading,  in  contrast  with  the  more  systematic  and  scientific  dis- 
course on  the  "Anatomy,  Physiology,  Pathology  and  Treatment  of 
Cancer,"  by  Walter  Hayle  Walshe,  published  with  additions  by  Dr.  J. 
Mason  Warren,  of  Boston,in  1844 ;  just  as  the  work  of  Walshe  is  in  marked 

•"Die  Lehre  von  der  Krebskrankheit  von  den  altesten  Zeiten  bis  zur  Gegenwart,"  (in  three  volumes)  by 
Dr.  Jacob  Wolff.  Jena,  1907,  1911  and  1913. 


STATISTICAL  METHOD  IN  MEDICINE 

contrast  with  the  recent  work  on  the  "Pathology  of  Growth,  with 
Special  Reference  to  Tumors,"  by  Charles  Powell  White,  or  the  treatise 
on  "Cancer  of  the  Breast,  with  Special  Reference  to  Operations  and  Their 
Results,"  by  Charles  B.  Lockwood,  London,  1913. 

Classification  of  Cancers  by  Walshe  (1844) 
In  the  absence  of  a  concise  definition  of  the  term  cancer  or  malignant 
disease,  an  exact  classification  of  tumors  is  obviously  impossible.  Nu- 
merous attempts  have  been  made  to  classify  tumors  according  to  funda- 
mental concepts  derived  from  the  sciences  of  anatomy,  physiology  and 
pathology,  but  all  of  these  classifications  vary  more  or  less  in  essential 
matters  of  detail.  An  early  classification  of  cancer,  published  in  the 
work  by  Walshe  in  1844,  is  of  present  interest  as  an  aid  in  the  interpre- 
tation of  the  cancer  mortality  statistics  of  a  period  which  practically 
coincides  with  the  beginnings  of  modern  death  registration.  The 
classification  by  Walshe*  is  given  in  Table  1,  Appendix  A. 

In  commenting  upon  this  classification  the  author  points  out  that  can- 
cer as  a  morbid  product  is  unequivocally  separated  from  others  belong- 
ing to  the  same  class,  as,  for  example,  pus  and  tubercles.  He  also  differ- 
entiated malignant  tumors  from  those  analogous  thereto,  such  as  fatty, 
fibrous  and  cartilaginous  tumors.  According  to  Walshe,  the  genus 
carcinoma  includes  three  species,  Encephaloid,  Scirrhus  and  Colloid; 
but  the  term  is  meant  to  be  equally  applicable  to  all  of  these  in  every 
stage  of  their  existence,  before  as  well  as  after  softening  and  ulceration. 
The  practical  diflBculties  of  an  exact  classificationf  are  emphasized  in 
the  statement  that 

Each  species  presents  a  certain  number  of  varieties.  In  a  column  apart  are  collected 
the  chief  synonyms,  under  which  the  species  have  been  described  by  different  writers. 
The  comprehension  of  the  work  of  these  authors  will,  we  trust,  be  facilitated  by  reference 
to  this  list;  and  the  dismay  naturally  felt  by  the  student  on  encountering  in  each  new 
treatise  one  or  more  names  of  diseased  formations  seemingly  distinct  from  all  those  he 
had  previously  become  acquainted  with,  will  be  in  some  measure  removed,  when  he  dis- 
covers that  such  diversity  of  names  by  no  means  implies  a  corresponding  multiplicity  of 
things. 

Some  of  the  terms  contained  in  the  Walshe  classification  are  now 
obsolete  and  meaningless.  The  classification,  however,  emphasizes  the 
painstaking  care  with  which  the  subject  was  considered  at  a  time  when, 
according  to  the  available  mortality  records,  all  forms  of  cancer  com- 
bined, as  well  as  non-malignant  tumors,  were  much  less  frequent  than 
they  are  to-day.  The  tumor  death  rate  of  Boston  for  1840-44  was 
only  25.9  per  100,000  of  population,  which  by  1909-13  had  increased 
to  109.6.  The  relative  frequency  of  cancer  at  different  periods  of  time 
was  discussed  by  Walshe,  with  special  reference  to  early  English  mor- 
tality data,  and  the  same  question  was  then  raised  as  now :  whether  the 
observed  increase  in  the  cancer  death  rate  was  real  or  only  apparent  and 
due  to  more  perfect  registration  and  increased  accuracy  in  diagnosis. J 

•  "The  Anatomy,  Physiology,  Pathology,  and  Treatment  of  Cancer,"  by  Walter  Hayle  Walshe,  M.  D.,  with 
additions  by  J.  Mason  Warren,  M.  D.,  Boston,  1844,  p.  6. 

tSee  Table  1,  Appendix  A. 

f'The  Anatomy,  Physiology,  Pathology,  and  Treatment  of  Cancer,"  by  Walter  Hayle  Walshe,  M.  D.,  with 
additions  by  J.  Mason  Warren,  M.  D.,  Boston,  1844,  pp.  127-129.  See  also  a  paper  by  LeConte  on  "Statistical 
Researches  on  Cancer,"  Southern  Medical  and  Surgical  Journal,  May,  1846,  Vol.  ii,  No.  5. 


THE  MORTALITY  FROM  CANCER 

Classification  by  Delafleld  (1871) 
In  1871  Francis  Delafield,  M.  D.,  who  vras  then  the  Curator  of  Belle- 
vue  Hospital,  published  a  new  grouping  of  morbid  growths,  from  which 
the  colloids*  included  by  Walshe  were  omitted.     The  classification  was 
as  follows: 

^  r  T         4.  f  Encephaloid 

Mahgnant|g^.^^i^^ 

(  Epithelioma 
Semi- malignant  ■<  Myoma 

(^  Enchondroma 
-p     •      ]  Glandular  tumors,  etc.,  tubercle, 
°^  (      and  some  forms  of  hypertrophy 

This  classification  was  based  upon  the  principle  that  the  mahgnancy  of 
a  tumor  could  be  conclusively  determined  only  by  microscopical  examina- 
tion and  the  character  of  the  cells,  whether  simple  or  compound.  The 
classification  was  a  substantial  advance  over  earlier  attempts  of  a  similar 
kind.  The  practical  impossibihty  of  exact  differentiation  between  mahg- 
nant  and  benign  tumors  is  shown  in  the  table,  by  the  inclusion  of  a 
group  of  semi-malignant  growths,  some  of  which  according  to  present 
theories  are  strictly  within  the  malignant  class.  Until  the  cause  or 
causes  of  tumor  growth  are  known  with  absolute  certainty,  the  basis  for 
scientific  classification  is  necessarily  non-existent.  It  has  properly  been 
pointed  out  in  this  connection  in  the  "  Text -book  of  General  Pathology, " 
by  Pembrey  and  Ritchie,  that 

The  purpose  of  any  attempt  at  classification  can  only  be  to  di^-ide  tumors  into  groups 
for  convenience  of  reference.  All  tumors  consist  of  cells  whose  appearance  and  quahties 
can  usually  be  related  to  those  of  some  normal  tissue.  Their  outstanding  feature  is  ca- 
pacity for  multiplication,  and  this  manifestation  of  acti\-ity,  again,  usually  reproduces 
more  or  less  closely  the  features  of  the  normal  development  of  the  normal  cells  from  which 
they  spring.  Taking  advantage  of  this  principle,  it  is  common  to  found  provisional  classi- 
fications on  the  differential  characters  assumed  early  in  embrj-onic  life  by  the  cells  from 
which  the  body  is  built  up.  The  rationale  of  such  a  procedure  is  that,  once  the  characters 
of  the  differentiation  are  assimaed,  they  tend  to  be  perpetuated  whatever  change  may 
occur  in  the  destiny  of  the  dinding  cell.  Certain  exceptions  to  this  rule  will  demand  con- 
sideration later.  Some  such  simple  classification  as  is  given  in  the  accompanjing  table 
suffices  for  the  practical  requirements  of  the  working  pathologist.! 

Classification  by  Pembrey  and  Ritchie  (1913) 
The  classification  referred  to  is  given  in  full  in  Table  2,  Appendix  A.  The 
authors  of  the  classification  frankly  concede  that  the  same  is  not  based 
on  strictly  scientific  principles,  but,  rather,  on  general  usage,  and  they 
concede  it  to  be  "still  extremely  unsatisfactory."  They  point  out  that 
a  large  variety  of  names  are  employed,  the  significance  of  wliich  can  only 
be  learned  by  long  experience.  In  a  general  way  these  names  indicate 
the  tissue  from  which  the  tumor  develops,  the  terminology  being  effected 
by  the  addition  of  the  Greek  afiix  -ojna  to  the  root  of  the  term  descriptive 
of  the  tissue.  They  add,  however,  to  their  classification  the  following 
brief  and  exceptionally  useful  explanation: 

A  papilloma  is  a  simple  tumor  of  epithelial  origin,  and  the  term  epithelioma  is  reserved 

The  word  colloid  means  glue-like  and  a  colloid  cancer  is  a  carcinoma  with  colloid  degeneration.  A  colloid 
cyst  is  a  cyst  with  jelly-like  contents. 

t"Teit-book  of  General  Pathology,"  edited  by  Pembrey  and  Ritchie,  London,  New  York,  1913,  pp.  232-233. 

8 


STATISTICAL  METHOD  IN  MEDICINE 

for  malignant  tumors  springing  from  skin  surfaces.  The  terms  applied  to  innocent  tumors 
springing  from  connective  tissues  constitute  a  large  group — a,  fibroma  being  such  a  tumor 
composed  of  fibrous  tissue,  a  myoma  of  muscular  tissue,  a  myxoma  of  mucoid  tissue,  a 
lipoma  of  fat,  a  chondroma  of  cartilaginous  tissue,  an  osteoma  of  bone  tissue.  Malignant 
tumors  springing  from  the  same  types  of  tissue  are  referred  to  as  sarcomata.  When 
sarcomata  spring  from  special  connective-tissue  structures,  there  is  prefixed  to  the  word 
a  term  indicating  the  special  tissue,  e.  g.,  myxosarcoma,  chondrosarcoma,  osteosarcoma. 
A  simple  tumor  springing  from  a  gland  is  usually  referred  to  as  an  adenoma;  but  the  term 
malignant  adenoma  is  often  used  to  designate  cylindrical-celled  tumors  of  the  intestine. 
The  greatest  confusion  centers  round  the  use  of  the  word  carcinoma.  This  term — the 
scientific  transliteration  of  the  popular  word  "cancer" — essentially  connotes  the  infiltra- 
tive capacity  of  a  malignant  growth,  and  has  often  been  applied  to  any  tumor  presenting 
this  feature.  According  to  present  clinical  convention,  however,  it  is  antithetical  to  sar- 
coma, and  this  indicates  malignant  tumors  of  epiblastic  or  hypoplastic  origin,  the  variety 
present  in  any  individual  case  being  specified  by  adding  the  name  of  the  organ  in  which  it 
occurs. 

Classification  by  Hatch  (1904) 

The  problem  of  tumor  classification  has  been  discussed  by  so  many 
writers  on  cancer  and  allied  subjects  that  it  would  be  quite  impracticable 
to  review  the  various  efforts  and  their  advantages  or  defects  on  this 
occasion.  In  an  admirable  address  on  "Cancer :  Its  Origin  and  Successful 
Treatment,"  by  Dr.  J.  Leffingwell  Hatch,  a  classification  of  tumors  was 
presented  according  to  the  five  pathological  blastodermic  regions  of  the 
body,  and  in  view  of  its  practical  utility  the  same  is  reproduced  in  full  in 
Table  3,  Appendix  A.  This  and  other  classifications  require  only  to  be 
brought  forward  to  emphasize  the  serious  technical  difficulties  confront- 
ing the  statistician  in  an  effort  to  deal  with  the  cancer  mortality  prob- 
blem  in  strict  conformity  to  the  principles  which  underlie  the  study  of 
all  collective  phenomena  or  the  science  of  averages  as  fundamentally 
conditioned  by  the  law  of  large  numbers.  It  is  primarily  for  the  purpose 
of  illustrating  the  practical  difficulties  of  the  cancer  problem  from  the 
medical  point  of  view  that  the  foregoing  considerations  have  been 
taken  into  account  in  what  is  intended  to  be  a  strictly  statistical  study 
of  a  subject,  which  nevertheless  is  at  root  a  problem  of  the  first  order 
of  importance  in  biology,  physiology,  pathology  and  therapeutics. 

Classification  by  Delafield  and  Prudden  (1913) 
In  the  Ninth  Edition  of  the  "Text-Book  of  Pathology,"  by  Delafield 
and  Prudden,  it  is  pointed  out  that  it  is  not  possible  to-day  "to  make  a 
satisfactory  scientific  classification  of  tumors ;  but  the  fact  that  they  are 
composed  of  structures  which  resemble  the  various  morphological  types 
of  tissue  found  in  the  normal  body  suggests  a  grouping  of  the  various 
forms  which  may  be  regarded  as  a  useful  and  suggestive  catalogue." 
The  classification  suggested  by  these  two  distinguished  authors  is  as 
follows  :* 

•  "The  attempt  has  often  been  made  to  classify  tumors  with  reference  to  the  developmental  history  of  the 
tissues  represented,  and  it  has  been  generally  believed  that  cells  once  differentiated  in  the  primary  embryonic 
layers  cannot  again  be  merged  in  type.  While  this  principle  holds  good  in  general,  especially  for  highly  dif- 
ferentiated forms,  certain  recent  studies  have  seemed  to  indicate  that  even  this  distinction  may  not  be  inflexible. 
However  this  may  be,  it  is  certain  that  the  cells  derived  from  one  embryonic  layer  may  under  special  con- 
ditions come  so  closely  to  resemble  in  morphology  those  of  another  layer  that  a  structural  differentiation,  with 
our  present  resources  at  least,  is  not  always  possible.  While,  therefore,  this,  which  is  called  the  histogenetic  prin- 
ciple of  classification,  is  most  suggestive  and  may  be  useful  in  connection  with  other  data  in  the  study  of  tumors, 
it  seems  to  the  writer  that  it  is  wiser  for  the  present  not  to  base  our  classification  too  largely  upon  embryological 
data  in  several  particulars  still  subject  to  controversy."  (Delafield  and  Prudden,  "Text -Book  of  Pathology," 
PP.367-3S8.) 

9 


THE  MORTALITY  FROM  CANCER 

CLASSIFICATION  OF  TUMORS 

(Delafield  and  Prudden) 

Connective-tissue  Type 

Normal  Tissue  Tumors 

Fibrillar  connective  tissue  Fibroma 

Mucous  tissue  Myxoma 

Embryonal  connective  tissue  Sarcoma 

Endothelial  cells  Endothelioma 

Fat  tissue  Lipoma 

Cartilage  Chondroma 

Bone  Osteoma 

Neuroglia  Glioma 

Muscle-tissue  Type — ^Myomata 

Normal  Tissue  Timiors 

Smooth  muscle  tissue  Leiomyoma 

Striated  muscle  tissue  Rhabdomyoma 

Nerve -tissue  Type — Neuromata 

Vascular- tissue  Type — ^Angioma ta 

Normal  Tissue  Tumors 

Blood-vessels  Angioma 

Lymph-vessels  Lymph-angioma 

Epithelial-tissue  Type 

Normal  Tissue  Tumors 

Glands  Adenoma 

Various  forms  of  epithelial  cells  Carcinoma 

and  associated  tissues 

Classification  by  White  (1914) 

The  most  recent  tumor  classification  occurs  in  a  treatise  on  "Tumors," 
by  Charles  Powell  White,  whose  definition  of  a  tumor  is  that  of  "a  mass 
of  cells,  tissues  or  organs  resembhng  those  normally  present  in  the  body 
but  arranged  atypically,  which  grows  at  the  expense  of  the  body,  without 
subserving  any  useful  purpose  therein."  The  classification  of  tumors 
adopted  by  White  is  based  on  the  three  dififerent  orders  of  units  of  organ- 
ization, that  is,  organs,  tissues  and  cells.  The  classification  is  given 
in  full  in  Table  4,  Appendix  A.  The  explanation  of  the  classification  is 
unusually  lucid  and  is  followed  by  an  extended  discussion  of  the  different 
types  of  tumors,  both  malignant  and  benign.  As  regards  the  nomen- 
clature adopted,  the  author  observes  that 

The  organomata  are  called  teratomata  from  their  resemblance  to  monsters.  The 
histiomata  are  named  from  the  tissue  which  forms  the  characteristic  feature  of  their 
structure  with  the  addition  of  the  termination  oma.  This,  however,  is  not  the  case  with 
the  epithelial  and  endothelial  histiomata  because  the  terms  "epithelioma"  and  "endo- 
thelioma" are  sometimes  applied  to  certain  forms  of  cytomata.  The  cytomata  are  properly 
named  from  the  cells  which  form  their  characteristic  elements.  Epithelial  cytomata 
are,  however,  called  by  the  old  Greek  name  carcinoma  from  the  supposed  resemblance 
of  these  tumors  to  a  crab  (Latin,  cancer) .  Supporting  tissue  cell  tumors  (desmocytomata) 
are  named  sarcomata.  Collectively  the  cytomata  are  called  cancers.  Compound  tumors 
are  named  by  compound  words  representing  the  various  constituents  of  the  tumors: 
hence  myxofibroma,  osteofibroma,  chondrosarcoma,  etc. 

The  classification  by  White  is  likely  to  prove  exceptionally  useful 
for  practical  purposes ;  but  he  properly  directs  attention  to  the  fact  that 

10 


STATISTICAL  METHOD  IN  MEDICINE 

intermediate  and  compound  tumors  exist  which  may  not  admit  of  a 
precise  classification.  In  view  of  the  importance  of  the  carcinomata, 
the  author's  subclassification  according  to  the  type  of  epithelial  cell 
of  which  the  tumors  are  composed  is  given  below: 

il  Squamous-celled  carcinoma 

2  Columnar-celled  carcinoma 

3  Spheroidal-celled  carcinoma 

4  Syncytial  carcinoma  or  syncytioma 

5  Endothelial  cytoma  or  endothelioma 

It  would  be  difficult  to  give  extended  consideration  to  these  principles 
of  classification  in  the  analysis  of  cancer  mortality  data.  It  would  require 
in  the  case  of  each  and  every  tumor  terminating  fatally  that  a  qualified 
microscopical  examination  be  made  of  the  growth  to  determine  with 
absolute  accuracy  its  precise  nature,  which,  aside  from  the  impos- 
sibility of  securing  the  consent  of  interested  parties  to  an  autopsy, 
might  prove  prohibitive  as  a  matter  of  expense.  The  classification, 
however,  is  exceedingly  interesting  and  valuable  for  scientific  purposes, 
and  it  would  seem  to  permit  of  being  adopted,  at  least,  by  surgeons  and 
large  hospitals,  with  facilities  for  microscopical  research.* 

The  Natural  History  of  Cancer 

The  essential  elements  of  the  cancer  problem  have  been  discussed  with 
exceptional  thoroughness  in  the  "Natural  History  of  Cancer,  with  Spe- 
cial Reference  to  Its  Causation  and  Prevention,"  by  W.  Roger  Williams, 
M.  D.  This  work  includes  extended  observations  on  the  geographical 
distribution  and  incidence  of  cancer,  the  observed  increase  in  the  disease, 
the  influence  of  age,  sex,  personal  history,  family  history,  etc.,  and, 
finally,  some  exceptionally  useful  observations  on  quasi-malignant 
pseudo-plasms  and  the  difficulties  experienced  in  the  exact  diagnosis  of 
cancers  and  their  various  causes.  The  considerable  use  of  statistical  data 
in  the  discussion  of  the  geographical  distribution  of  cancer  as  well  as  its 
topographical  distribution  throughout  the  United  Kingdom  forcibly  illus- 
trates the  practical  importance  of  the  statistical  method  and  the  possi- 
bilities of  an  increase  in  usefulness  by  more  trustworthy  data  derived 
from  official  reports  on  death  registration,  the  reports  of  hospitals  and 
special  institutions  for  the  treatment  of  cancer,  and  last,  but  not  least, 
the  extended  experience  of  life  insurance  companies.  The  essential 
statistical  elements  of  the  cancer  problem  are,  in  the  order  of  their 
relative  importance,  age,  sex,  race,  occupation,  locality  and  family 
history.  Each  of  these  elements  requires  to  be  separately  considered, 
with  a  due  regard  to  the  varieties  of  cancer  and  the  organs  and  parts  of 
the  body  affected.  Among  other  important  factors  are  conjugal  or 
marital  condition,  religious  belief,  density  of  population  and  special 
residential  conditions,  topography,  soil,  climate,  habits  and  personal 
history  of  past  diseases,  including,  of  course,  traumatisms  of  every 
kind.     When  it  is  conceded  that  all  of  these  factors  more  or  less  influ- 

•A  tumor  classification  according  to  the  histologic  constituents,  physical  manifestations  and  seats  of  pre- 
dilection, by  Gould  and  Pyle,  as  contained  in  the  second  edition  of  the  Pocket  Cyclopedia  of  Medicine  and 
Surgery,  is  given  in  Table  S,  Appendix  A,  for  convenient  reference. 

11 


THE  MORTALITY  FROM  CANCER 

ence  the  local  incidence  of  cancer,  it  is  self-evident  that  the  statistical 
correlation  must  become  extremely  complex,  according  to  the  methods 
of  analysis  employed.  Excepting,  however,  the  age  and  sex  factors,  it 
would  appear  that  thus  far  no  other  special  conditioning  circumstances 
affecting  cancer  frequency  in  human  beings  have  been  shown  to  be  of 
sufficient  local  importance  to  invalidate  general  conclusions  based  on 
crude  cancer  death  rates,  not  standardized  for  sex  and  for  age.  It 
would  obviously  he  an  unpardonable  statistical  error  to  compare  without 
at  least  a  word  of  caution  the  crude  cancer  death  rates  of  long-settled 
countries,  including  a  considerable  proportion  of  aged  persons,  with  the 
crude  rate  of  a  neio  country  consisting  chiefly  of  immigrants  and  their 
offspring,  largely  of  the  non-cancerous  period  of  life.  As  a  rule,  how- 
ever, in  the  absence  of  such  a  standardization  for  age,  the  crude  cancer 
death  rates  are  a  sufficiently  accurate  index  of  local  cancer  frequency  in 
the  case  of  countries  free  from  abnormal  population  conditions,  such,  for 
illustration,  as  are  found  in  the  excessive  proportion  of  aged  persons 
in  a  country  like  Ireland  and  the  abnormally  low  proportion  of  old 
people  found  in  recently  settled  countries  or  localities,  as  typified 
in  the  case  of  Australia.*  The  same  conclusion  applies  to  countries  or 
localities  with  an  abnormal  sex  distribution,  as  best  shown  in  the  case 
of  new  settlements  for  lumbering  or  mining  purposes,  where  the  popula- 
tion consists  almost  exclusively  of  men.  The  two  fundamental  factors 
which  invariably  condition  the  local  cancer  death  rate  are,  first,  the 
varying  sex  and,  second,  the  varying  age  distribution  of  the  population. 
For  the  large  majority  of  civilized  countries  the  cancer  death  rates  are 
available  by  sex,  but  it  is  possible  for  only  a  relatively  small  proportion 
of  countries  and  localities  to  calculate  the  required  cancer  death  rates 
by  sex  and  divisional  periods  of  life. 

Standardized  Cancer  Death  Rates 

The  importance  of  these  observations  is  concisely  brought  out  by  the 
following  facts  derived  from  the  last  annual  report  (1913)  on  the  mortality 
of  the  registration  area  of  the  United  States.  The  total  number  of  deaths 
from  cancer  was  49,928,  and  of  this  number  20,045  were  deaths  of  males 
and  29,883  were  deaths  of  females.  Since  the  sex  proportion  of  the 
population  in  the  registration  area  is  almost  the  same,  the  relative 
cancer  death  rates,  according  to  sex,  differed  in  the  proportion  of  10 
to  16,  as  determined  by  a  male  cancer  death  rate  of  61.3  and  a  female 
cancer  death  rate  of  97.6  per  100,000  of  population  for  the  year  1913. 
Since  the  registration  area  includes  only  about  65  per  cent,  of  the  total 
population,  it  is  a  safe  assumption  that  the  approximate  number  of 
deaths  from  cancer  in  the  Continental  United  States  for  the  year  1915 
may  be  conservatively  estimated  at  80,000,  and  of  this  number  32,100 
would  be  deaths  of  males  and  47,900  would  be  deaths  of  females.  It  is 
therefore  self-evident  that  in  the  calculation  of  cancer  death  rates,  as 
far  as  practicable,  the  sex  factor  requires  to  be  taken  into  account. 

Cancer  is  so  peculiarly  a  function  of  age,  that  for  the  purpose  of  pre- 
cise calculation  the  various  populations  considered  require  to  be  reduced 
to  a  standard  or  uniform  distribution,  resulting  in  what  is  technically 

*According  to  recent  census  returns  the  proportion  of  persons  aged  65  and  over  was  10.0  per  cent,  for 
Ireland,  against  only  4.3  per  cent,  for  the  Australian  Commonwealth. 

12 


STATISTICAL  METHOD  IN  MEDICINE 

known  as  "corrected"  death  rates.  A  more  strictly  scientific  term  would 
be  "standardized"  death  rates.  The  importance  of  the  age  factor  in 
cancer  mortality  is  illustrated  in  the  simple  statement  that  in  the  United 
States  registration  area  during  the  year  1913  out  of  49,887  deaths  from 
cancer  at  all  known  ages,  42,173  deaths,  or  84.5  per  cent.,  occurred  at 
ages  45  and  over.  In  the  Ordinary  experience  of  The  Prudential  Insur- 
ance Company  of  America,  1886-1913,  the  proportionate*  mortality  from 
cancer  at  ages  45  and  over  was  8.5  per  cent,  for  males  and  17.8  per 
cent,  for  females.  Among  insured  females  in  the  Company's  Ordinary 
experience  at  ages  45  and  over,  cancer  was  the  leading  cause  of  death. 
In  most  of  the  civilized  countries  of  the  world  the  female  cancer  death  rate 
exceeds  the  male  cancer  death  rate,  but  there  are  some  important  ex- 
ceptions to  this  rule  which  demand  special  consideration.  In  England 
and  Wales,  in  the  year  1911,  the  crude  cancer  death  rate  of  males  was 
89.1  per  100,000  of  population,  whereas  the  female  cancer  death  rate 
was  108.8,  a  difference  of  19.7  per  100,000  of  population.  The  stand- 
ardized rates  according  to  sex,  that  is,  corrected  for  variations  in  the 
age  constitution  of  the  two  populations,  were  82.3  for  males  and  99.8 
for  females,  a  difference  of  17.5  per  100,000  of  population.  These 
differences,  it  will  be  granted,  are  not  of  sufficient  importance  to 
invalidate  the  general  conclusion  that  the  male  cancer  death  rate  of 
England  and  Wales  is  normally  below  the  cancer  death  rate  of  females. 
A  much  more  pronounced  difference,  however,  in  the  cancer  death 
rates  according  to  sex  is  disclosed  when  the  rates  for  rural  districts  are 
compared  on  the  basis  of  the  necessary  standardization  for  age  and 
sex.  According  to  the  report  of  the  Registrar-General  for  1911,  the 
crude  cancer  death  rate  of  males  living  in  rural  districts  was  90.5, 
which  was  reduced  to  68.9  when  corrected  for  age  on  a  standardized 
basis,  or  a  difference  of  21.6  per  100,000  of  population.  The  cancer 
death  rate  for  females  was  changed  from  a  crude  rate  of  113.4  to  a 
standardized  rate  of  90.8,  or  a  difference  of  only  12.6  per  100,000  of 
population.  This  result  is  accounted  for  by  the  large  proportion  of  aged 
women  in  the  English  rural  population,  so  that  as  a  general  rule  the  rural 
cancer  death  rates  of  the  two  sexes  are  more  urgently  in  need  of  stand- 
ardization for  age  and  sex  than  the  crude  rates  of  cities. f 

Cancer  a  Function  of  Age  and  Senility 
The  age  factor  in  cancer  is  unquestionably  a  disturbing  one  in  general 
mortality  statistics.  The  frequently  expressed  opinion,  however, 
that  the  increase  in  the  average  duration  of  life  during  recent  years  is 
a  sufiicient  explanation  of  the  apparent  increase  in  the  cancer  death 
rate  is  seriously  misleading.  The  argument  that  "those  who  to-day 
live  long  enough  to  be  attacked  by  cancer  would  in  the  majority  of 
cases,  had  they  lived  in  years  gone  by,  have  succumbed  earlier  to  small- 
pox, consumption  and  other  scourges,  which  have  since  been  so  greatly 
reduced  in  frequency,"  is  equally  erroneous.     Cancer  death  rates,  when 

*The  term  proportionate  mortality  means  the  number  of  deaths  from  cancer  in  every  100  deaths  from 
all  causes  at  the  divisional  period  of  life  specified.  Additional  details  regarding  the  Company's  cancer  mortality 
experience  are  given  in  Tables  1  to  27,  Appendix  D. 

*  tThe  official  statistics  of  cancer  for  England  and  Wales  are  contained  in  the  annual  reports  of  the  Registrar- 
General  of  Births,  Deaths  and  Marriages.  Special  consideration  has  been  given  to  cancer  in  recent  reports, 
particularly  the  74th,  75th  and  76th,  for  1911,  1912  and  1913. 

13 


THE  MORTALITY  FROM  CANCER 

calculated  for  divisional  periods  of  life,  measure  the  rate  of  mortality  at 
those  particular  periods  and  without  reference  to  any  other.  If  it  can 
be  shown  that  the  cancer  death  rate  at  ages  45  and  over  is  higher  to-day 
than  in  former  years,  the  higher  rate  is  evidence  of  a  true  increase  in 
cancer  liability  among  equal  numbers  affected  and  is  not  the  result  of 
a  mere  shifting  in  disease  liability  of  equal  degree  from  one  group  of 
causes  to  another.  From  a  physiological  point  of  view,  the  age  factor 
in  cancer  is  the  equivalent  of  the  observed  retrogression  of  cells  to  an 
extremely  primitive  form,  typical  of  true  senility,  or  old  age.  As  ob- 
served, however,  by  Sir  Jonathan  Hutchinson:  "Sometimes  it  is  not  so 
much  senility  of  the  entire  organism,  as  what  we  may  term  local  senility 
and  old  age  of  the  tissues  concerned,  which  is  primitive  and  does  not 
correspond  to  that  of  the  body  as  a  whole."  "Nor  indeed,"  he  con- 
tinues, "is  it  correct  to  say  that  the  degree  of  senility  is  the  measure  of 
proneness  to  cancer,  for  it  is  not  in  conditions  of  advanced  senile  atrophy 
that  cancer  is  most  apt  to  occur,  but,  rather,  in  its  commencement. 
Tissues  and  organs  which  are  just  commencing  to  decline  are  those  which 
are  most  prone  to  develop  it."  That  cancer  processes  are,  in  fact,  evi- 
dences of  a  senile  change  seems  to  be  well  established  by  the  researches 
of  Hastings  Gilford  and  others,  whose  conclusions  are  in  conformity 
to  the  theory  advanced  many  years  ago  by  Sir  James  Paget  regarding 
errors  in  the  chronometry  of  life.  In  the  words  of  this  distinguished 
authority:  "The  local  defects  of  working  power  require  more  often  to  be 
thought  of  in  the  time  rate  of  life  in  the  defective  parts  and  we  should 
think  of  the  age  of  each  part  as  not  always  wholly  or  exactly  expressed 
by  the  time  that  has  elapsed  since  it  was  first  formed."* 

A  reference  to  these  observations  seems  pertinent  as  a  precaution 
against  the  prevailing  view  that  cancer  is  a  specific  function  of  age, 
instead  of  its  being  more  accurately  a  function  of  senility,  which 
as  a  rule  by  some  years  precedes  normal  old  age.  In  fact,  as  observed 
by  W.  R.  Williams,  "centenarians  and  other  very  aged  persons  are 
shown  to  be  little  prone  to  malignant  tumors."  In  contrast,  it  is  well 
known  that  tumors  occurring  in  early  life  are  much  more  rapidly  fatal 
than  those  which  occur  later  in  life.  Since  tumors  in  youth  are  as  a  rule 
of  the  sarcoma  type,  that  is,  cancers  of  connective-tissue  formation,  it  is 
sincerely  to  be  regretted  that  in  most  of  the  available  cancer  statistics 
the  required  distinction  of  carcinoma  and  sarcoma  should  not  have  been 
made,  with  a  due  regard  to  age  and  sex.  The  importance  of  such  a 
distinction  has  been  clearly  brought  out  by  Bashford  in  one  of  his  papers 
on  the  age  incidence  in  cancer  mortality. f 

The  Factor  of  Race  in  Cancer  Mortality 
The  race  factor  in  cancer  mortality  statistics  is  also  of  considerable 
importance,  and  the  cancer  death  rates  for  countries  with  a  population 
consisting  of  widely  different  ethnic  elements  require  to  be  corrected 

*See  in  this  connection  an  interesting  editorial  in  the  New  York  Medical  Record,  May  31,  1902,  on 
Errors  in  the  Chronometry  of  Life,  with  special  reference  to  the  observations  and  conclusions  of  the  late  Sir 
James  Paget. 

t  Scientific  Reports  on  the  Investigations  of  the  Imperial  Cancer  Research  Fund,  Part  I,  Statistical  In- 
vestigation of  Cancer,  London,  1905.  See  also  in  this  connection  the  tables  on  cancer  and  sarcoma,  by  single 
years  of  life,  derived  from  the  Industrial  experience  of  The  Prudential  Insurance  Company  of  America,  in  the 
Appendix  to  the  chapter  on  Cancer  as  a  Problem  in  Life  Insurance  Medicine. 

14 


STATISTICAL  METHOD  IN  MEDICINE 

or  given  in  detail  on  this  ground.  As  a  typical  illustration  the  Island 
of  Ceylon  may  be  referred  to,  where  the  population  consists  of  such 
widely  different  ethnic  types  as  Europeans,  Sinhalese  and  Tamils.* 
According  to  the  hospital  returns  of  Ceylon  for  1913,  out  of  88,724 
admissions  for  all  causes,  only  217,  or  0.24  per  cent.,  were  on  account  of 
malignant  growths,  and  287,  or  0.32  per  cent.,  on  account  of  non- 
malignant  growths.  Of  the  217  admissions  for  malignant  growths, 
45,  or  20.7  per  cent.,  terminated  fatally,  whereas  out  of  287  admissions 
for  non-malignant  growths,  7,  or  2.4  per  cent.,  terminated  in  death. 
Another  illustration  is  the  District  of  Columbia,  where  of  the  total 
population  in  1910,  28.5  per  cent,  were  of  African  descent.  All  of  the 
available  evidence  is  to  the  effect  that  the  recorded  cancer  death  rate 
of  primitive  races  is  materially  below  the  average  for  civilized  countries. 
The  argument  frequently  advanced  that  this  difference  is  much  more 
apparent  than  real  is  hardly  applicable  to  the  conditions  under  which 
the  available  information  for  native  races  has  been  obtained.  Quali- 
fied European  physicians  practising  for  years  among  the  native  Egyp- 
tians, the  primitive  races  of  East  and  West  Africa  and  the  North  Amer- 
ican Indians  are  in  entire  agreement  that  malignant  tumors  of  every 
variety  are  quite  rare  among  the  uncivilized  or  semi-civilized  types 
of  mankind.  The  evidence  regarding  the  infrequency  of  cancer  among 
native  races  has  been  carefully  examined  and  admirably  set  forth  in 
"The  Natural  History  of  Cancer,"  by  W.  R.  Williams;  and  equally 
convincing  evidence  will  subsequently  be  presented  in  the  statistical 
portion  of  this  work. 

In  the  United  States  previous  to  the  Civil  War,  cancer  among  the 
negro  population  was  relatively  rare,t  and  particularly  was  this  observed 
to  be  true  by  plantation  physicians  as  regards  cancer  of  the  uterus 
among  negro  women.  At  the  present  time,  under  conditions  of  un- 
restrained personal  freedom,  the  difference  in  the  cancer  mortality  of  the 
two  races  is  decidedly  less  pronounced,  though,  as  a  rule,  the  general 
cancer  death  rate  of  the  white  population  is  still  considerably  in  excess 
of  the  cancer  death  rate  of  the  negro.  At  ages  40  and  over,  for  illustra- 
tion, the  mortality  from  cancer  of  the  stomach  and  liver  in  the  District 
of  Columbia  for  the  decade  ending  with  1910  was  105.5  per  100,000  of 
population  for  white  males,  against  73.1  for  colored  males,  and  84.5  for 

*During  1908-12  the  cancer  death  rate  of  Ceylon  by  race  was  as  follows:  Europeans,  15.9;  Burghers, 
25.9;  Sinhalese,  7.3;  Tamils,  5.4;  Moors,  6.5;  Malays,  3.2;  all  races  combined,  6.8  per  100,000  of  population. 
In  a  letter,  of  May  1,  1914,  Mr.  Bertram  Hill,  Registrar-General  of  Ceylon,  writes  me  as  follows:  "The  figures 
in  the  Ceylon  Vital  Statistics  as  to  causes  of  death  must  be  accepted  with  caution.  In  the  majority  of  cases 
diagnosis  is  made  by  persons  who  have  had  no  medical  training  or  at  least  no  training  on  modern  scientific 
lines  and  who  probably  would  not  be  able  to  diagnose  cancer  if  they  came  across  it.  Then,  again,  Europeans 
return  to  Europe,  as  a  rule,  if  they  are  afflicted  with  any  serious  disease,  and  the  age  constitution  of  the 
European  population  is  not  favorable  to  the  development  of  cancer;  most  European  Civil  Servants  retire  at 
the  age  of  55  or  under  and  return  to  England  for  the  rest  of  their  lives.  A  similar  practice  exists  among 
planters  and  merchants.  There  are  then  comparatively  few  Europeans  over  55  years  of  age  in  Ceylon 
[7.1  %].  It  is  worthy  of  note  that  of  the  406  fatal  cases  of  cancer  which  were  recorded  in  this  Island  in  1912  no 
less  than  107,  or  26  per  cent.,  were  due  to  cancer  of  the  buccal  cavity.  This  is  attributed  to  the  habit  of  chewing 
betel:  the  chew  consisting  of  the  betel  leaf,  tobacco,  arecanut  and  lime.  This  'quid'  is  kept  constantly  in 
the  mouth  and  no  doubt  sets  up  irritation,  which  results  in  cancer.  Apart,  however,  from  the  unreliability 
of  the  figures,  I  believe  that  cancer  is  a  comparatively  rare  disease  in  Ceylon,  though  the  rate  has  risen  from  6.4 
in  1910  to  9.8  per  100,000  in  1912.  It  is  worthy  of  note  that  the  cancer  mortality  in  the  Straits  Settlements 
(which  have  a  climate  closely  resembling  that  of  Ceylon)  was  9.6  per  100,000  last  year." 

tSee  in  this  connection  a  discussion  of  the  mortality  from  tumor  among  the  American  negro  population  IQ 
my  "Race  Traits  and  Tendencies  of  the  American  Negro,"  New  York,  1896, 

15 


THE  MORTALITY  FROM  CANCER 

white  females,  against  64.5  for  colored  females.  In  marked  contrast, 
the  mortality  from  cancer  of  the  generative  organs  in  the  District 
of  Columbia  was  84.2  per  100,000  of  population  for  white  women,  against 
123.1  for  colored  women.  These  illustrations  sufficiently  emphasize  the 
importance  of  giving  due  consideration  to  the  fundamental  element  of 
race,  aside,  of  course,  from  the  factors  of  sex  and  age.* 

Limitations  of  the  Present  Inquiry 

It  is  not  the  present  purpose  to  enlarge  upon  the  numerous  factors 
and  circumstances  which  condition  the  observed  variations  in  cancer 
frequency  in  different  countries  and  at  diflferent  periods  of  time.  The 
main  object  is  to  facilitate  the  statistical  study  of  the  cancer  problem 
by  making  available  the  more  important  general  data  for  the  civilized 
world,  arranged  as  far  as  practicable  in  a  uniform  manner  and  reduced  to 
rates  calculated  by  uniform  methods.  The  available  amount  of  statisti- 
cal information  is  of  astonishing  proportions.  Most  of  the  original 
reports  containing  cancer  mortality  statistics  are  unavailable  to  the 
student  of  the  subject  from  the  medical  and  surgical  point  of  view. 
There  is  much  pretended  accuracy  in  numerous  statistical  tabulations 
which,  however,  are  often  found  wanting,  in  that  widely  varying  methods 
of  estimating  the  population  have  been  employed  and  frequently  no 
correction  has  been  made  for  changes  in  population  during  intercensal 
periods.  Even  some  of  the  more  pretentious  international  tables  of 
cancer  statistics  fail  in  the  matter  of  accuracy  of  detail,  f  It  has  there- 
fore been  necessary  for  the  present  purpose  to  reconsider  the  entire 
material,  and  unless  otherwise  stated,  all  of  the  tables  presented  are 
derived  from  official  sources,  that  is,  either  from  the  original  official 
reports  on  mortality  or  by  means  of  correspondence  with  the  registra- 
tion officials  in  charge.  The  populations  for  intercensal  periods  have  as 
a  rule  been  recalculated,  in  conformity  with  the  arithmetical  method. 
The  rates  have  been  checked  at  least  twice  throughout,  but,  consider- 
ing the  vast  amount  of  material  brought  together,  from  so  many 
different  sources,  absolute  accuracy  must  be  assumed  unattainable. 

The  chief  purpose  of  the  present  investigation,  as  stated  before,  is 
to  make  the  existing  statistical  data  available  to  the  student  of  the 
subject,  to  whom  most  of  the  facts  would  otherwise  be  inaccessible.  A 
second  important  object  has  been  to  determine  the  true  tendency  of  the 
cancer  death  rate,  or,  in  other  words,  the  rate  of  increase  or  decrease  in 
cancer  mortality  throughout  the  civilized  countries  of  the  world.  The 
controversial  aspects  of  the  question  as  to  whether  cancer  is  on  the 
increase  or  not  are  separately  considered  in  another  portion  of  this  work. 
A  third  object  of  the  present  inquiry  has  been  to  ascertain  as  far  as 
practicable  the  relative  incidence  of  cancer  according  to  the  organs  or 

•Proportion  of  Negro  Population,  Census  1910:  Charleston,  S.  C,  52.8  per  cent.,  Mobile,  Ala.,  44.2  per 
cent,  and  New  Orleans,  La.,  26.3  per  cent. 

tThe  principal  sources  of  international  cancer  statistics  are:  Statistique  Internationale  du  Mouvement 
de  la  Population  d'apres  les  Registres  d'Etat  Civil  (publiee  par  le  Ministere  du  Travail  et  de  la  Prevoyance 
Sociale,  Paris,  1907  ot  1913);  Statistique  Demographique  des  grandesVillesdu  Monde  pendant  les  Annees  1880- 
1909  (publiee  par  le  Bureau  Municipal  de  Statistique  d'Amsterdam);  Annual  Reports  of  the  Registrar-General 
of  Births,  Deaths,  and  Marriages  in  England  and  Wales.  See  also  in  this  connection  the  discussion  on  Cancer 
in  the  first  volume  of  "Handworterbuch  der  sozialen  Hygiene,"  by  Grotjahn  and  Kaup,  Leipzig,  1912,  and 
the  section  on  Statistics  in  the  third  volume  of  "Lehre  von  der  Krebskrankheit,"  by  J.  WolEf,  Jena,  1913. 

16 


STATISTICAL  METHOD  IN  MEDICINE 

parts  of  the  body  affected,  with  a  due  regard  to  age  and  sex,  in  different 
countries  of  the  world.  It  is  a  remarkable  fact  that  for  most  of  the 
countries  the  required  information  is  not  available.  Absolute  complete- 
ness in  the  tabular  analysis  has  therefore  not  been  attainable;  but  every 
effort  has  been  made  to  present  the  more  useful  data,  at  least,  for  the 
countries  with  admittedly  trustworthy  systems  of  registration,  based 
upon  reasonably  accurate  methods  of  death  certification. 

Urgency  of  Complete  Information 

The  difficulties  of  statistical  research  into  the  cancer  problem  are 
needlessly  increased  by  the  common  neglect  on  the  part  of  those  re- 
sponsible for  the  official  publications  on  cancer  mortality  to  provide 
the  necessary  information  as  regards  the  organs  and  parts  of  the  body 
affected.  The  rather  common  practice  of  only  assigning  cancer  as  a 
cause  of  death,  without  regard  to  the  organs  or  parts  of  the  body  affected, 
materially  impairs  the  practical  utility  of  the  available  information. 
The  conviction,  however,  is  gradually  gaining  ground  that  the  required 
details  with  regard  to  cancer  are  as  essential  as  they  are  with  regard  to 
fevers.  It  would  be  as  logical  and  as  useful  to  return  deaths  from  fevers 
without  stating  whether  typhoid,  malarial  or  some  other  form  as  it  is  to 
return  deaths  from  cancer  without  stating  whether  of  the  stomach  or 
liver,  the  uterus,  the  breast,  etc.  Such  details  are  absolutely  indispen- 
sable to  the  more  scientific  purposes  of  statistical  research  into  the  natural 
history  of  malignant  disease.  It  does  not  involve  much  additional  labor 
on  the  part  of  the  attending  physician  to  enter  on  the  death  certifi- 
cate the  particulars  as  regards  the  organ  or  part  of  the  body  affected 
by  the  cancerous  growth  causing  death,  but  the  absence  of  such  informa- 
tion often  precludes  the  highest  attainable  degree  of  completeness 
in  the  practical  use  of  cancer  mortality  returns;  in  its  final  analysis 
the  question  as  to  whether  cancer  is  on  the  increase  or  not  reduces 
itself  to  the  problem  as  to  whether  cancer  of  any  particular  form  or 
type  is  more  or  less  prevalent  now  than  in  former  times.  It  has 
probably  never  been  seriously  maintained  by  any  one  at  all  familiar 
with  the  subject  of  cancer  mortality  statistically  considered  that  all 
forms  of  cancer  were  on  the  increase,  any  more  than  one  would  be  justi- 
fied in  concluding  that  because  the  general  death  rate  is  declining  the 
decrease  in  the  rates  affects  every  disease  or  cause  of  death.  It  should 
be  perfectly  obvious  that  the  general  death  rate  may  be  decreasing  re- 
gardless of  the  fact  that  the  rate  is  increasing  at  certain  ages  or  from 
certain  causes;  and  the  general  death  rate  from  cancer  may  be  increas- 
ing regardless  of  the  fact  that  there  may  be  a  decline  in  the  frequency 
of  malignant  disease  as  affecting  certain  organs  or  parts,  or  certain 
special  elements  of  the  population,  particular  age  groups,  etc.* 

*The  argument  has  been  put  forward  by  the  Director  of  the  Imperial  Cancer  Research  Fund  that  "All  the 
statements  widely  circulated  in  the  newspapers  as  to  the  increase  of  cancer  as  a  whole  should  be  ignored  and 
attention  only  paid  to  those  in  which  cancer  affecting  the  different  parts  of  the  body  are  considered."  This 
conclusion  is  not  justified  by  the  facts,  for  as  a  general  principle  it  may  safely  be  asserted  that  cancer  of  all  im- 
portant organs  and  parts  of  the  body  is  on  the  increase  in  most  of  the  localities  for  which  the  data  are  available 
and  that  the  occasional  exceptions  to  the  rule  as  regards  cancer  of  particular  organs  or  parts  of  the  body  which 
may  show  a  decline  are  not  of  equal  importance.  Of  course,  the  rate  of  increase  for  the  various  organs  and 
parts  of  the  body  varies  widely,  but  this  does  not  affect  the  broad  conclusion  that  malignant  disease,  considered 
as  a  group,  shows  a  decided  tendency  towards  an  increase,  relatively  to  the  population  affected,  throughout 
the  civilized  world. 

17 


THE  MORTALITY  FROM  CANCER 

The  Problem  of  Cancer  Increase 
In  the  classical  essay  on  "The  Alleged  Increase  of  Cancer,"  by  Messrs. 
King  and  Newsholme,  originally  read  before  the  Royal  Society  on  May 
4,  1893,  the  statistical  study  of  the  material  considered  was  arranged 
according  to  external  or  accessible  cancers  and  internal  or  inaccessible 
cancers.  The  grouping  adopted  was  rather  arbitrary  and  in  some  re- 
spects misleading,  as  wiU  be  subsequently  shown  in  the  more  extended 
discussion  of  the  question  as  to  whether  cancer  is  actually  on  the  increase 
or  not.  In  a  corresponding  study  made  by  the  Imperial  Cancer  Re- 
search Fund  three  groups  of  cancerous  affections  were  adopted,  accessible, 
inaccessible  and  intermediate.  It  is  self-evident  that  cancer  diagnosis 
must  be  decidedly  more  difficult  in  the  case  of  inaccessible  cancers  than 
in  the  case  of  those  conveniently  accessible  by  means  of  external  exam- 
ination. The  classification,  by  Bashford,  of  accessible,  inaccessible  and 
intermediate  cancers,  the  terms  referring,  of  course,  to  the  seat  of  pri- 
mary, growth,  is  of  much  practical  value,  and  for  this  reason  the  same  is 
given  in  full  in  Table  8,  Appendix  A,  together  with  a  note  on  the  original 
classification  adopted  by  King  and  Newsholme. 

Effect  of  Better  Diagnosis  on  Cancer  Statistics 

Improved  diagnosis,  especially  when  based  upon  autopsies  followed 
by  the  microscopical  study  of  the  tissues  affected,  must  necessarily  tend 
to  increase  the  cancer  death  rate;  but  there  are  reasons  for  believing 
that  this  factor  of  uncertainty  in  cancer  mortality  statistics  is  not  of  suffi- 
cient importance  to  seriously  invalidate  the  practical  utility  of  the  general 
cancer  death  rate.  For  even  in  the  case  of  autopsies,  mistakes  in  diag- 
nosis, as  conclusively  shown  by  Dr.  Bashford,  are  not  entirely  avoidable. 
The  margin  of  error  is  probably  not,  however,  as  wide  in  cancer  death 
certification  as  is  frequently  assumed  to  be  the  case.  The  liability  to 
error  is  perhaps  as  great,  if  not  greater,  in  the  classification  of  cancer 
mortahty  returns  reported  originally  in  conformity  to  a  more  or  less 
indefinite  medical  terminology.  As  previously  shown  the  earlier  classi- 
fications of  tumors,  whether  malignant  or  benign,  indicate  that  the 
tendency  to  classify  benign  tumors  as  malignant  was  probably  greater 
than  the  liability  in  modern  medical  practice  to  erroneously  diagnose 
malignant  growths  as  tumors  of  an  innocent  kind.  That  within  recent 
years  there  have  been  further  improvements  in  diagnosis  can  not  be 
questioned  by  any  one  familiar  with  the  progress  of  medical  science  in 
this  and  other  countries.  That  there  have  also  been  improvements  in 
the  more  scientific  classification  of  diseases  must  be  readily  admitted, 
and  more  so  in  view  of  the  increasing  use  of  the  International  Classifica- 
tion of  Causes  of  Death,  which  in  the  case  of  cancer  provides  for  seven 
large  groups  and  numerous  subdivisions  under  each. 

The  Place  of  Cancer  in  Death  Classification 

The  term  "cancer,"  for  statistical  purposes,  as  explained  in  the  Manual 
of  the  International  List  of  Causes  of  Death,  is  a  general  one,  and  made  to 
include  all  forms  of  malignant  neoplasms.  The  list  of  these,  as  given 
in  the  original  classification,  is  given  in  full  detail  for  the  purpose  of 
convenient  reference,  in  Table  6,  Appendix  A.  It  is  stated  in  the  Manual 
that  "the  location  of  the  cancer,  or  preferably,  as  recommended  by  the 

18 


STATISTICAL  METHOD  IN  MEDICINE 

Committee  of  the  American  Medical  Association,  the  seat  of  origin  of 
the  cancer,  if  known,  should  always  be  stated."  The  seven  groups 
adopted  for  general  purposes  of  classification  are:  first,  cancer  and  other 
malignant  tumors  of  the  buccal  cavity,  second,  cancer  and  other  malig- 
nant tumors  of  the  stomach  and  liver,  third,  cancer  and  other  malignant 
tumors  of  the  peritoneum,  intestines  and  rectum,  fourth,  cancer  and 
other  malignant  tumors  of  the  female  generative  organs,  fifth,  cancer 
and  other  malignant  tumors  of  the  breast,  sixth,  cancer  and  other 
malignant  tumors  of  the  skin,  seventh,  cancer  and  other  malignant 
tumors  of  other  organs  or  of  organs  not  specified.  With  regard  to  the 
last,  it  is  pointed  out  that  "This  is  a  residual  title  that  includes  all  deaths 
from  cancer  that  cannot  be  assigned  to  the  preceding  titles,  and  espe- 
cially those  in  which  the  location  or  origin  of  the  disease  is  not  stated." 
It  is  suggested  that  "inquiry  should  be  made  in  such  cases  and  fuller 
information  obtained,  if  possible."* 

In  the  subsequent  discussion  of  the  cancer  statistics  of  the  United 
States  registration  area  by  organs  and  parts  of  the  body,  only  these 
seven  groups  are  considered,  since  the  information  in  detail  for  the 
numerous  subdivisions  is  not  at  present  made  public  by  the  Division  of 
Vital  Statistics  of  the  Census  Office.  An  urgent  recommendation  has 
therefore  been  made  to  the  Director  of  the  Census  by  the  Executive 
Committee  of  the  American  Society  for  the  Control  of  Cancer  that  this 
omission  should  be  made  good  in  the  future  by  the  more  complete 
publication  of  the  facts,  or,  in  other  words,  the  publication  of  cancer 
mortality  returns  in  full  detail,  according  to  the  organs  or  parts  of  the 
body  affected.  It  is  to  be  hoped  that  this  suggestion  will  be  carried  into 
effect  in  the  publication  of  future  reports  on  the  mortality  statistics  of 
the  registration  area.f 

For  the  scientific  study  of  the  cancer  problem  it  is,  however,  of  the 
utmost  importance  that  the  available  statistical  information  should  be 
published  in  more  detail,  and  several  suggestive  illustrations  of  the 
feasibility  of  this  method  are  given  in  statistical  appendices,  particu- 
larly in  Appendix  G,  for  foreign  countries.  The  earlier  returns  in 
detail  for  New  York  and  Philadelphia  may  also  be  referred  to  as 
decidedly  more  useful  than  the  abbreviated  statistics  published  at  the 
present  time,  in  conformity,  however,  to  the  International  Classifica- 
tion of  Causes  of  Death. 

Non-Malignant  Tumors 

The  Manual  of  the  International  List  of  Causes  of  Death  classifies 
other  tumors,  excepting  those  of  the  female  generative  organs,  as  a 

*  See  Tables  6  and  7,  Appendix  A. 

tin  conformity  to  this  resolution  the  Director  of  the  Census  has  given  instructions  to  the  Division  of  Vital 
Statistics  to  make  hereafter  the  following  subdivisions  in  the  cancer  classification: 

CANCER  AND  OTHER  MALIGNANT  TUMORS  OF  THE— 

39.  Buccal  cavity  40.  Stomach  and  Liver                        41.  Peritoneum,  intestines  and  rec- 

Lip  Pharynx                                                       tum 

Tongue    '  (Esophagus                                            Mesentery  and  peritoneum 

Mouth  Stomach                                                 Intestines 

Jaw  Liver  and  gall-bladder                          Rectum 

Other  Other                                                      Other 

42.  Female  Generative  Organs  45.  Other  organs:  Larynx,  Lungs  and  Pleura,  Pancreas,  Kidneys  and 

43.  Breast  Suprarenals,  Prostate,  Bladder,  Brain,  Bones  (except  jaw).  Testes. 
t4.  Skin  Other. 

]9 


THE  MORTALITY  FROM  CANCER 

separate  group,  including  all  forms  of  non-malignant  neoplasms.  These 
are  quite  numerous  and  on  account  of  their  importance  the  details 
are  given  in  full  in  Table  6,  Appendix  A,  as  derived  from  the  official 
classification  of  Causes  of  Death.  Non-cancerous  uterine  tumors  are 
also  separately  considered  in  the  International  Classification  and 
the  details  of  this  group  are  given  in  Table  7,  Appendix  A,  together 
with  the  official  list  of  cysts  and  other  tumors  of  the  ovary,  hydatid 
tumors  of  the  liver,  biliary  calculi,  calculi  of  the  urinary  passages  and 
ulcers  of  the  stomach;  it  being  understood,  of  course,  that  in  all  cases 
the  supplementary  classification  applies  only  to  non-malignant  disease, 
and  that  the  facts  having  reference  thereto  are  included  in  this  dis- 
cussion only  as  a  matter  of  convenience  for  the  more  complete  study 
of  tumor  science  comprehended  under  the  term  oncology.* 

*0n  the  classification  of  diseases,  with  special  reference  to  cancer,  see  Bellevue  Hospital  Nomenclature  of 
Diseases  and  Conditions,  adopted  by  the  Board  of  Trustees,  1903,  revised  edition,  1911 ;  Massachusetts  General 
Hospital  Nomenclature,  second  edition,  revised  and  enlarged,  1914;  Statistical  Experience  Data  of  Johns  Hop- 
kins, Hospital,  Baltimore,  1892-1911,  F.  L.  Hoffman,  1913,  including  observations  on  the  plan  and  scope  of 
nosography,  Bellevue  classification  of  diseases,  and  a  list  of  references  to  disease  registration  and  the  practical 
utility  of  institutional  and  other  mortality  records. 


20 


CHAPTER  II 

THE  STATISTICAL  BASIS  OF  CANCER  RESEARCH 

Limitations  of  Statistical  Analysis — DiflSculties  of  Precise  Classification — Early  Obser- 
vations on  Cancer  Statistics — Need  of  an  Exhaustive  Study — Uniform  Methods  of 
Tabulation  and  Analysis — Recognition  of  Cancer — Importance  of  Microscopical 
Research. 

The  sources  of  statistical  information  regarding  cancer  frequency 
throughout  the  world  are :  first,  the  official  mortality  statistics,  second, 
the  statistics  of  institutions  for  the  medical  or  surgical  treatment  of 
cancer  patients,  third,  the  recorded  individual  clinical  data  of  physi- 
cians and  surgeons,  fourth,  the  collective  experience  data  of  life  insur- 
ance companies,  fifth,  the  results  of  special  cancer  censuses,  sixth,  mis- 
cellaneous data  of  public  institutions,  such  as  homes  for  the  aged, 
almshouses,  prisons,  retreats  for  inebriates,  etc. 

Recognized  Limitations  of  Statistical  Analysis 
Of  the  world's  population,  estimated  for  1912  at  1,750,000,000,  there 
are  more  or  less  trustworthy  cancer  mortality  statistics  for  a  population 
of  about  450,000,000,  or  26.0  per  cent,  of  the  whole.  For  this  civilized 
portion  of  the  world,  the  intrinsic  value  of  the  data  available  varies  quite 
considerably,  not  only  for  the  different  countries  as  such,  but  also  for  the 
several  component  parts  of  the  same  country , that  is,the  political  divisions 
or  subdivisions  as  the  case  may  be.  The  liability  to  error  in  the  interpre- 
tation of  cancer  statistics  is  therefore  quite  serious  and  no  conclusions 
advanced  in  the  subsequent  discussion  are  to  he  accepted  without  this  impor- 
tant qualification.  As  is  the  case,  however,  in  all  mortality  statistics,  there 
is  a  well-establistied  tendency  on  the  part  of  such  errors  to  more  or  less 
balance  one  another;  and  the  observed  regularities  in  cancer  occurrence 
in  different  countries  and  different  sections  of  the  same  country  warrant 
the  conviction  that  the  element  of  error  in  cancer  statistics  is  apparently 
not  materially  greater,  if  as  great,  than  in  the  case  of  other  important 
diseases,  such  as  typhoid  fever,  appendicitis,  diabetes,  etc.  The  initial 
liability  to  error  in  cancer  statistics  is  naturally  the  ever-present  possibility 
of  mistakes  in  clinical  diagnosis.  This  liability,  however,  has  probably 
been  more  clearly  recognized  in  cancerous  complaints  than  in  many 
other  diseases  of  modern  life,  as  brought  out  in  an  interesting  early 
treatise  on  "  Diseases  Which  Have  Been  Confounded  with  Cancer,  and 
Also  Some  Critical  Remarks  on  Some  of  the  Operations  Performed  in 
Cancerous  Cases,"  by  John  Pearson,  Surgeon  of  the  Lock  Hospital,  Lon- 
don, 1793.    As  observed  by  this  author: 

For  as  language  is  not  rich  enough  to  furnish  words  that  will  perfectly  denote  all  the 
different  shades  of  colour,  though  their  dissimilitude  is  obvious  when  presented  to  the  mind; 
so  there  is  a  species  of  practical  knowledge,  composed  of  simple  ideas  derived  from  observa- 
tion, for  which  no  competent  terms  have  yet  been  contrived,  and  which  no  periphrasis  can 
adequately  describe. 

Pearson  was  evidently  a  careful  observer,  for  he  remarks: 

The  application  of  analogical  reasoning  to  diseases,  is  a  very  nice  and  delicate  imder- 
taking;  it  requires  much  acuteness  and  sagacity,  and  lies  not  within  the  province  of 

21 


THE  MORTALITY  FROM  CANCER 

an  ordinarj'  observer.  But  in  practice  it  is  often  of  more  importance  to  discern  wherein 
complaints  differ,  than  wherein  they  agree;  and  that  sort  of  knowledge  which  might  very 
properly  enable  a  man  to  found  classes,  orders,  genera  and  species,  would  be  quite  insuflB- 
cient  to  conduct  him  to  a  rational  and  successful  mode  of  treatment.  While  nosologists 
therefore  are  debating  whether  the  cancer  ought  to  stand  in  the  class  of  cachexiae  or  locales; 
let  us  pursue  a  more  interesting  object,  and  endeavor  to  ascertain  by  what  signs  the  Cancer 
may  be  distinguished  from  all  other  diseases. 

Present  Difificulties  of  Precise  Classification 

This  question  of  exact  diagnosis,  differentiation  and  classification  has 
not  yet  been  answered  to  the  satisfaction  of  the  medical  and  surgical 
profession.  Criticisms,  therefore,  of  faulty  cancer  statistics  lie  primarily 
against  those  who  are  responsible  for  errors  in  diagnosis  and  mistakes  of 
subsequent  classification,  and  not  against  those  who  perform  the  equally 
arduous  though  perhaps  mechanically  less  difficult  task  of  statistical 
tabulation  and  analysis. 

Even  in  so  modern  a  work  as  the  "Index  of  Differential  Diagnosis  of 
Main  Symptoms,"  by  various  writers,  edited  by  Herbert  French,  M.  D., 
and  published  in  a  new  edition  in  1913,  tumors  are  considered  under  the 
general  term  of  "Swellings,"  because  of  the  practical  impossibility 
of  a  precise  differentiation  between  tumors  of  doubtful  malig- 
nancy and  tumors  of  doubtful  innocency,  as  well  as  between  mere 
swellings  which  fall  within  the  characteristic  tumor  class  and  those 
which  obviously  do  not  belong  there.*  The  same  argument,  of  course, 
may  be  applied  to  ulcers,  which  are  also  quite  difficult  of  precise  classi- 
fication; and  reference  may  be  made  here  to  a  treatise  on  "The 
Management  of  Ulcers,"  with  a  dissertation  on  white  swellings  of  the 
joints,  including  observations  on  cancerous  ulcers  and  the  causes  of 
cancerous  disorders,  by  Benjamin  Bell,  M.  D.,  published  in  1784.  An 
extended  review  of  the  early  medical  literature  on  cancer  fails  to  reveal 
the  required  evidence  of  serious  misconception  of  the  nature  of  cancerous 
complaints  in  different  parts  of  the  human  body  sufficient  to  discredit 
the  practical  utihty  of  the  available  vital  records  with  reference  to  this 
disease  or  group  of  diseases,  f 

It  is  nearly  seventy  years  ago  since  the  statistical  aspects  of  the  cancer 
problem  were  first  discussed  in  the  United  States,  in  a  contribution  by 
John  Le  Conte,  entitled  "Statistical  Researches  on  Cancer,"  published 
in  the  Southern  Medical  and  Surgical  Journal  for  May,  1846.  The  data 
used  were  the  statistics  of  the  Department  of  the  Seine  for  the 
eleven  years  ending  with  1840  and  the  statistics  of  England  and  Wales 
for  1838-39.     Le  Conte  directed  attention  to  the  necessity  of  sound 

*In  the  words  of  Mitchell  Banks,  as  quoted  by  Coley,  in  a  discussion  of  the  increase  of  cancer  in  a  paper 
read  before  the  Southern  Surgical  and  Gynecological  Association,  December  14, 1909,  "While  the  diagnosis  of 
cancer  is  probably  made  much  more  frequently  now  than  in  former  times,  it  required  little  skill  to  make  the 
diagnosis  at  the  time  of  the  death  of  the  patient.  The  diagnosis  at  such  a  time  was  by  no  means  beyond  the 
ability  of  even  the  rural  practitioner  of  fifty  years  ago." 

fThe  following  definition  of  cancer  is  from  "The  Physical  Dictionary,"  by  Stephen  Blancard,  M.  D.,  6th 
edit.,  London,  1715  : 

"Cancer :  The  Cancer  is  a  round,  livid  or  blackish  Tumor,  circumscrib'd  with  turgid  Veins  replete  with 
Blood,  either  with  or  without  Exulceration,  arising  from  black,  corrupted  stagnant  Bile  diversify 'd  many 
ways.  The  true  Cancer  is  restrained  to  the  Breasts  only  of  Women,  and  the  Scapulae  of  Men.  There  is  a 
white  Cancer,  which  is  a  certain  white  Chalky  Recrement  occupying  the  inward  parts  of  the  Mouth,  and  the 
whole  Tongue  of  Infants ;  and,  except  deterg'd  and  cleans'd  in  time,  will  exulcerate." 

"Carcinoma,  Carcinus,  or  Cancer,  a  Tumour  that  arises  always  in  the  Glands,  from  saline,  sulphureous, 
sharp,  and  melancholy  thick  Humours.  It  is  round,  hard,  livid,  painful,  at  the  beginning  as  big  as  a  Pea,  but 
afterwards  it  is  surroimded  with  great  swelling  Vei7is  which  resemble  the  Feet  of  a  Crab,  tho'  not  always." 

22 


STATISTICAL  BASIS  OF  RESEARCH 

statistical  methods  and  particularly  to  the  fallacy  of  determining  the 
rate  of  cancer  frequency  in  the  form  of  a  proportion  of  the  mortality 
from  all  causes.  Le  Conte  contributed  a  subsequent  paper  on  "Vital 
Statistics  Illustrated  by  the  Laws  of  Mortality  from  Cancer"  to  the 
Western  Lancet,  March,  1872,  and  the  earlier  papers,  in  part,  with  ma- 
terial additions,  were  reprinted  in  a  final  contribution  on  "Vital  Statis- 
tics and  the  True  Coefficient  of  Mortality  Illustrated  by  Cancer"  to  the 
tenth  biennial  report  of  the  State  Board  of  Health  of  California,  Sacra- 
mento, 1888.  The  fundamental  principle  that  the  mortality  from  cancer 
is  a  function  of  age  was  clearly  recognized  by  Le  Conte,  and  he  was 
one  of  the  very  first  to  direct  attention  to  its  importance  in  statistical 
research.     The  article  also  draws  attention  to  the  fact  that 

Nearly  all  of  our  statistical  data  appear  to  indicate  that  in  the  case  of  cancer  there  has 
really  been  a  secular  increase  in  mortality,  both  in  France  and  in  England  and  Wales.  It 
would  be  premature  to  attempt  to  express  this  increment  in  numbers  as  a  time-factor  in  our 
formula  for  the  influence  of  age  on  the  mortality  from  cancerous  diseases.  The  rational 
discussion  of  such  questions  must  be  postponed  until  some  zealous  investigator  of  vital 
statistics  arises,  who  has  the  leisure  and  the  courage  to  properly  analyze  the  vast  accumu- 
lation of  valuable  facts  which  are  entombed  in  the  mortuary  registers  of  the  last  forty 
years. 

As  regards  the  probable  cause  of  this  presumed  increase  in  the  mor- 
tality from  cancer,  it  is  pointed  out  by  Le  Conte  that  it  may  be  proper 
to  remind  the  reader  that 

To  some  extent,  the  augmentation  may  be  only  apparent;  since  it  may  arise  from  more 
careful  registration,  from  improvements  in  pathology,  and  from  greater  accuracy  in 
diagnosis.  It  is  difficult  to  estimate  the  influence  of  these  circumstances.  But  there  is 
another  cause  of  this  apparent  increase  of  mortality  which  is  far  more  definite.  It  is  a  well 
established  fact,  that  the  mean  duration  of  human  life  has,  even  within  a  comparatively 
short  time,  been  sensibly  increased,  by  the  rapid  advancement  of  medical  science  and  by 
a  more  philosophical  application  of  hygienic  and  sanitary  regulations. 

In  a  footnote  to  the  article  a  reference  is  made  to  one  of  the  earliest 
papers  on  the  increase  in  cancer,  contributed  to  the  Transactions  of  the 
Society  of  the  Alumni  of  the  College  of  Physicians  and  Surgeons  of  the 
State  of  New  York,  1842.  The  possible  effect  on  the  cancer  death  rate 
of  improved  methods  of  diagnosis  and  death  certification  on  the  basis  of 
autopsies  was  clearly  recognized  by  Le  Conte,  who  remarks  that 

Perhaps  the  habit  of  making  necroscopic  examinations  may  be  more  common  in  the 
French  metropolis  than  it  is  in  England,  and  thus  a  greater  number  of  internal  cancers 
may  be  detected  and  registered.  But  it  is  hardly  reasonable  to  suppose  that  the  dis- 
parity growing  out  of  this  circumstance  would  amount  to  the  enormous  proportion  of  4  to 
1,  In  view  of  M.  Tanchou's  idea,  that  the  mortality  from  cancer  is  in  a  direct  ratio 
to  the  intensity  of  human  ci\'ilization,  it  may  be,  to  some  extent,  consolatory  to  the 
inhabitants  of  England  to  discover  that  their  more  recent  mortuary  records,  from  1860 
to  1863,  inclusive,  indicate  a  very  remarkable  increase  in  the  death  rate  from  this  disease.* 

Considering  the  very  limited  amount  of  accurate  statistical  informa- 
tion available  at  this  period,  the  general  conclusions  arrived  at  by  Le 
Conte  are  in  remarkable  conformity  to  the  facts  disclosed  by  subsequent 
experience.     The  article  is  an  illuminating  contribution  to  the  statistical 

*Probably  the  very  earliest  cancer  mortality  statistics  are  contained  in  the  "Collection  of  the  Yearly  Bills 
of  Mortality,  1657-1758,"  London,  1759.  The  returns  are  limited  to  the  city  of  London.  Cancer  is  specifi- 
cally enumerated  during  every  year,  but  the  term  includes  gangrene  and  fistula.  Excluding  the  years  during 
which  plague  was  epidemic  it  is  found  that  between  1651-1758  out  of  1,980,037  deaths  from  all  causes  5,123,  or 
0.26  per  cent.,  were  from  cancer,  including  gangrene  and  fistula.  The  proportion  was  highest  during  1651-64, 
or  0.34  per  cent.,  and  lowest  during  1741-58,  or  0.20  per  cent.    (See  Table  15d,  Appendix  G.) 

23 


THE  MORTALITY  FROM  CANCER 

study  of  cancer  and  conclusively  proves  that  for  some  seventy  years 
at  least  the  question  of  cancer  increase  has  received  more  or  less  quali- 
fied and  critical  consideration  in  the  United  States. 

Observations  on  English  Cancer  Statistics 

As  early  as  1866,  in  a  paper  contributed  to  the  Journal  of  the  Royal 
Statiscal  Society  of  London,  Dr.  W.  L.  Sargant,  in  an  essay  on  the 
"Vital  Statistics  of  Birmingham,"  observed  that 

Of  all  the  diseases  to  which  a  separate  column  is  assigned,  the  one,  I  presume,  about 
which  there  can  be  the  least  dispute  is  cancer.  The  number  of  deaths  it  causes  is  small, 
however,  being  only  about  1  per  cent,  of  all  deaths;  but  it  is  twice  as  great  among  females 
as  among  males. 

The  uniformity  of  the  numbei-  in  different  places  is  remarkable.  In  the  whole  of  En- 
gland and  Wales,  out  of  10,000  persons  living,  2  males  and  4  females  die  of  cancer  each  year. 
The  same  number,  2  males  and  4  females,  die  of  it  each  year  in  Liverpool,  Manchester,  Leeds 
and  Wolverhampton.  In  Birmingham  and  Sheffield,  there  are  also  2  male  deaths,  but  5 
instead  of  4  females;  in  London,  again,  there  are  2  males,  but  6  females;  in  Bristol  there 
are  no  less  than  4  males  and  6  females.  Possibly  the  excess  in  these  towns  is  caused  by 
the  influx  to  the  hospitals  of  patients  from  a  wider  neighborhood. 

At  a  meeting  of  the  British  Medical  Association  lately  held  in  Leamington,  there  arose 
a  discussion  on  the  question,  whether  cancer  was  a  local  disease,  or  whether  it  was  a  result 
of  an  ill  condition  of  the  body.  If  it  were  a  result  of  ill  condition,  we  should  find  more  of 
it  in  an  unhealthy  place  than  in  other  places;  more  in  Liverpool  than  in  the  whole  of  Eng- 
land and  Wales.  But  in  fact  we  find  that  out  of  10,000  persons  living,  the  same  number 
die  in  Liverpool  that  die  in  the  whole  country.* 

Medical  progress  varies  widely  in  different  countries  and  at  different 
periods  of  time.  New  diseases  are  recognized  in  some  countries  far  in 
advance  of  others,  in  consequence  of  better  methods  of  medical  educa^ 
tion,  postgraduate  courses,  facilities  for  research,  etc. ;  but  there  would 
seem  to  be  no  exception  to  the  rule  that  until  about  fifty  years  ago  all 
cancerous  complaints,  whether  external  or  internal,  were  considered  by 
the  medical  and  surgical  profession  as  of  comparatively  rare  occurrence. 
This  conclusion  is  reflected  in  the  general  vital  statistics  of  civilized  coun- 
tries previous  to  about  1880,  in  the  early  experience  of  life  insurance  com- 
panies and  in  the  early  medical  literature  on  the  subject.  During  the 
last  fifty  years,  however,  the  gradual  increase  in  cancerous  complaints  has 
been  more  and  more  recognized,  and  the  following  is  a  suggestive  ex- 
tract from  a  discussion  in  connection  with  the  accuracy  of  statistics 
of  the  causes  of  death  by  Longstaff ,  a  painstaking  student  of  statistical 
problems,  contributed  to  the  Journal  of  the  Royal  Statiscal  Society  of 
London, t  in  which  it  is  said  that 

Cancer,  in  contrast  to  renal  disease,  is  twice  as  fatal  to  women  as  to  men:  it  is  rare  in 
early  life,  but  steadily  increases  in  frequency  from  the  age  of  25  upward.  Cancer  has  in- 
creased 38  per  cent,  in  males,  24  per  cent,  in  females,  the  greater  increase  in  males  being 
probably  due  to  the  fact  that  cancer  of  the  stomach  and  liver,  which  is  commoner  in  men 
than  women,  is  much  more  difficult  of  diagnosis  than  cancer  of  the  female  breast  or  of  the 
uterus.  Hence  improved  medical  skill  affects  the  retm^ns  for  it  more.  The  loss  of  life 
due  to  the  increased  mortality  from  cancer  amounts  to  1,187  males  and  1,661  females,  of 
which  seven-eighths  are  above  the  age  of  45.  A  recent  writer  (H.  P.  Dunn,  F.  R.  C.  S.,  in 
British  Medical  Journal,  1883,  pp.  708,  etc.),  said  he  was  convinced  that  the  long- 
continued  and  steady  increase  of  cancer  was  not  apparent  only,  and  accounted  for  by  in- 
creased accuracy  of  diagnosis  and  registration,  but  was  an  undoubted  fact;  the  cause  is 
quite  unknown,  but  must  probably  be  sought  in  some  abnormal  circumstances  of  our 

*"The  Vital  Statistics  of  Birmingham  and  Seven  Other  Towns,"  by  Dr.  W.  L.  Sargant,  published  in  the 
Journal  of  the  Royal  Statistical  Society,  London,  1866. 
t  Journal  of  the  Royal  Statistical  Society,  London,  1884. 


STATISTICAL  BASIS  OF  RESEARCH 

artificial  existence.  It  should  be  remembered  that  very  few,  if  indeed  any,  recover  from  this 
much  dreaded  disease,  and  also  that  it  chiefly  attacks  after  the  reproductive  age  is  past. 
From  these  facts  we  may  draw  the  consolation  that  if  there  are  many  killed,  there  are  no 
wounded,  and  that  although  the  tendency  to  cancer  may  be  handed  down  to  ofiFspring,  they 
are  not  born  enfeebled  in  consequence  of  their  parents'  ailment. 

WTien  this  was  written  the  number  of  deaths  from  cancer,  including 
sarcoma,  in  England  and  Wales  was  15,198,  equivalent  to  a  cancer  death 
rate  for  the  year  1884  of  56.5  per  100,000  of  population.  For  the  year 
1911  the  cancer  death  rate  of  England  and  Wales  was  99.3;  if,  therefore, 
in  1884,  on  account  of  mistaken  diagnosis  or  erroneous  classification,  the 
true  cancer  death  rate  had  been  the  same  as  in  1911,  26,725  deaths  would 
have  been  assigned  to  other  causes  instead  of  being  properly  assigned  to 
cancer  or  sarcoma.  Considering  the  then  attained  degree  of  medical 
education  and  professional  efficiency,  this  would  seem  incredible. 
Modern  Improvements  in  Diagnosis  and  Classification 

At  the  same  time,  there  can  be  no  question  of  doubt  that  improved 
diagnosis  and  more  scientific  methods  of  classification  have  contributed 
towards  the  observed  increase  in  the  cancer  death  rate  of  practically 
every  civilized  country  throughout  the  world;  but  it  would  seem  quite 
impossible,  considering  the  very  material  rise  in  the  cancer  death 
rate  during  the  last  thirty  or  forty  years,  that  this  increase  should  be 
only  apparent  and  not  real,  and  chiefly  the  result  of  improved  methods 
of  diagnosis  and  classification.  If  the  same  argument  were  applied  to 
many  other  diseases,  even  more  obscure  and  difficult  of  exact  diagnosis 
than  at  least  the  external  cancers,  it  would  amount  to  this :  that  deaths 
must  have  actually  occurred  which  are  not  a  matter  of  official  record,  in 
view  of  the  fact  that  in  practically  all  of  the  more  important  countries 
the  mortality  from  all  causes  has  relatively  declined  during  the  last  gener- 
ation.* Since  there  has  been  no  material  increase  in  the  death  rate  from 
all  causes  at  ages  over  40,  and  in  the  case  of  some  important  causes  even 
a  decline,  it  is  evident  that  if  cancer  ranks  to-day  foremost  among  the 
diseases  showing  an  actual  rise  in  the  rate,  and  practically  from  year  to 
year  for  more  than  a  generation,  this  increase  can  not  possibly  be  ex- 
clusively or  even  largely  the  result  of  improved  diagnosis  or  more 
scientific  methods  of  classification. 

Necessity  for  an  Exhaustive  Study 

Thus  far  no  thoroughly  scientific  study  of  cancer  statistics  has  been 
made  with  a  view  to  determine  the  relevancy  of  the  criticism  frequently 
made  against  the  validity  of  the  statistical  method.  The  need  of  such 
an  investigation  is  quite  obvious;  but  the  difficulty  lies  in  the  required 
dual  familiarity  with  both  the  medical  and  the  statistical  difficulties  of  the 
problem.  In  this  respect  the  criticisms  of  the  statistical  method  in  cancer 
research  on  the  part  of  the  Director  of  the  Imperial  Cancer  Research  Fund 
are  merely  negative  and  of  very  limited  practical  utility.  The  same 
conclusion  applies  in  part  to  the  following  observations  by  Delafield  and 
Prudden,  in  the  ninth  edition  of  their  "Text-book  of  Pathology," 
page  353,  published  in  1911: 

It  has  become  e\'ident  of  late  that  much  of  the  statistical  lore  of  tumors,  especially  of 
malignant  types,  which  has  been  handed  on  from  one  writer  to  another,  is  in  need  of  a 

*For  a  discussion  of  the  decline  of  the  death  rate  throughout  the  world,  see  my  address  on  "  The  Signifi- 
cance of  a  Declining  Death  Rate,"  proceedings  First  National  Conference  on  Race  Betterment,  1914. 

25 


TEE  MORTALITY  FROM  CANCER 

critical  re^Tsion,  and  that  many  of  the  current  opinions  regarding  malignant  tumors  are 
based  upon  alleged  observations  of  doubtful  validity  and  upon  inferences  hastily  and  illogi- 
caliy  drawn.  Among  these  opinions  needing  revision  may  be  mentioned  the  alleged  rela- 
tive rapid  increase  in  the  frequency  of  cancer,  which  rests  upon  data  obviously  faulty;  the 
contention  that  metastases  in  maUgnant  tumor  are  closely  analogous  with  metastases  in 
infective  processes  and  indicate  the  infective  nature  of  the  former;  the  view  that  carcinoma 
has  been  in  many  instances  directly  conveyed  by  contact  from  a  ^'ictim  of  the  disease  to  a 
well  person;  the  successful  inoculation  of  carcinoma  of  man  into  the  lower  animals.  None 
of  these  points  has  been  sustained  by  rehable  data. 

It  has  become  e\"ident  that  a  new  departure  is  necessary  in  the  study  of  tumors  and  that 
this  is  especially  urgent  along  two  lines:  first,  in  the  collection  of  more  rehable  statistics, 
which  shall  embrace  not  only  man,  but  the  lower  animals  as  well;  and,  second,  the  initiation 
of  careful  and  extended  experimental  studies  of  the  tumors,  especially  the  mahgnant 
tumors,  of  the  lower  animals,  in  which  such  gro-nlhs  frequently  occiu"  spontaneously. 

TMien  along  these  lines  the  data  relating  to  the  biology  of  tumors  shall  have  been 
gathered  on  a  large  scale,  the  outlook  will  be  brighter  for  the  study  of  the  fundamental 
problems  of  the  inciting  factors  in  tumors  and  of  promising  measures  for  their  treatment. 

Of  these  interesting  suggestions,  the  first,  regarding  the  collection  of 
more  reliable  statistics,  can  be  complied  with  at  the  present  time  only  to 
the  extent  of  a  more  complete  and  trustworthy  presentation  of  the  avail- 
able official  and  other  statistical  data  relating  to  the  cancer  problem  in 
its  various  aspects  throughout  the  world.  Since  no  such  effort  has 
heretofore  been  attempted  in  a  really  comprehensive  manner,  it  is  to  be 
hoped  that  if  the  present  work  falls  short  of  providing  an  absolutely 
trustworthy  basis  of  conclusions  regarding  the  apparent  or  actual  in- 
crease in  cancer  frequency,  the  very  considerable  amount  of  statistical 
material  brought  together  will,  for  the  first  time,  at  least  afford  an 
adequate  basis  of  facts  for  the  strictly  scientific  and  critical  statistical 
study  of  the  subject.  The  material  presented  is  so  extensive  in  the  quan- 
tity of  data  and  the  wealth  of  detail  that  it  may  safely  be  asserted  that 
no  problem  in  human  mortahty  has  heretofore  been  considered  on  the 
basis  of  an  equally  adequate  amount  of  statistical  data.  On  the  basis  of 
this  information  it  should  not  be  impossible  to  ascertain  with  approxi- 
mate accuracy  at  least  the  direction  in  which  the  required  improve- 
ment in  cancer  statistics  can  be  made  with  least  difficulty  and  with  the 
assurance  of  practical  utility. 

The  statistical  aspects  of  the  cancer  problem,  with  a  due  regard  to  the 
geographical  distribution  of  the  disease,  have  been  considered  at  some 
length  in  the  third  volume  of  the  treatise  on  cancer  by  J.  Wolff.  The 
statistical  references,  however,  are  general,  and  no  attempt  is  made  at 
correlation  or  uniformity  in  the  presentation  of  the  facts.  Many  of  the 
citations  are  very  interesting  and  exceedingly  useful  in  the  statistical 
study  of  the  cancer  problem;  but  the  data  are  inadequate  for  the  pur- 
pose of  determining  the  true  rate  of  increase  in  cancer  frequency  in 
civilized  countries,  not  only  for  all  forms  of  cancer,  but  for  special  forms 
in  particular  localities.  The  investigation  by  Wolff  includes  topo- 
graphical and  geological  considerations,  climate,  race,  religion,  urban  and 
rural  conditions,  wealth  and  poverty,  occupation,  sex,  age,  etc.  The 
results  of  the  investigation  are  summarized  by  this  author  for  the 
purpose  of  answering  the  question  as  to  whether  cancer  is  actually 
or  only  apparently  on  the  increase,  but  no  definite  conclusion  is  reached. 
In  brief,  it  is  said  that  the  evidence  is  not  available  to  prove  that  there 
has  been  an  actual  increase  in  cancer  mortality,  especially  of  gastric 

26 


STATISTICAL  BASIS  OF  RESEARCH 

cancer,  and  that,  in  any  event,  the  observed  increase  is  not  sufficient 
to  cause  serious  apprehension  on  the  part  of  the  pubHc.  This  conclusion 
is  not  in  conformity  to  the  results  of  the  present  investigation,  which 
prove  that  within  less  than  forty  years  the  rate  of  mortality  from  cancer 
has  practically  doubled  and  that  the  actual  number  of  deaths  from 
cancer  in  the  civilized  portion  of  the  world  for  which  reasonably  trust- 
worthy data  are  available  exceeds  500,000  per  annum. 

Uniform  Methods  of  Tabulation  and  Analysis 

The  material  for  the  present  investigation  has,  unless  otherwise 
stated,  been  derived  from  the  original  official  reports  or  by  means  of 
correspondence  with  the  official  department  in  charge  of  the  collection 
of  cancer  mortality  statistics.  As  far  as  practicable  the  sources  of  in- 
formation are  indicated  for  every  table,  so  as  to  facilitate  further 
research  with  particular  reference  to  the  mortality  experience  of  foreign 
countries.  It  has  not  been  feasible,  as  a  rule,  to  bring  the  data  further 
down  than  to  the  end  of  the  year  1912. 

The  tabulation  and  analysis  of  each  country  as  far  as  practicable  are 
made  to  include  the  mortality  by  organs  and  parts  of  the  body  affected, 
with  the  required  distinction  of  age  and  sex.  The  mortality  rates  are 
given  in  a  uniform  manner,  on  the  basis  of  100,000  of  population. 
With  but  a  few  exceptions,  the  rates  are  original  calculations  based 
upon  new  or  revised  estimates  of  the  population  for  intercensal 
years.  The  age  and  sex  distribution  of  the  population  has,  as  a 
rule,  been  derived  from  the  official  census  reports.  The  use  of  non- 
official  data  has  generally  been  avoided,  but  occasionally  such  data 
have  been  included  for  the  purpose  of  completeness,  with  the  reason- 
able assurance  that  the  authors  responsible  therefor  had  derived  their 
original  returns  from  trustworthy  sources. 

The  present  discussion  does  not  include  an  extended  critical  study  of 
new  statistical  methods  of  cancer  research.  It  has  seemed  of  more  prac- 
tical importance  to  provide  the  student  of  the  cancer  problem  with  the 
available  material  for  statistical  research,  rather  than  with  theories  or 
criticisms  however  well  justified  by  the  facts.  It  would  unquestion- 
ably serve  a  most  useful  purpose  if  the  method  originally  suggested  by  the 
Director  of  the  Imperial  Cancer  Research  Fund  regarding  uniform 
records  of  hospitals  in  cancer  cases  were  adopted  by  at  least  the  lead- 
ing institutions  providing  medical  or  surgical  treatment  for  cancerous 
complaints.  Such  uniformity  would  go  far  towards  eliminating  serious 
errors,  which  to  a  considerable  degree  invalidate  the  comparative  cancer 
statistics  of  different  countries  of  the  world. 

The  same  conclusion,  of  course,  applies  to  the  general  adoption  of  the 
standard  death  certificate  and  the  more  general  use  of  the  international 
classification  of  causes  of  death.  Another  difficult  problem  in  this 
connection  is  the  universal  adoption  of  a  generally  suitable  blank  for 
supplementary  cancer  inquiries.  As  an  aid  towards  the  better  solution  of 
this  phase  of  the  cancer  problem,  the  most  essential  forms  in  practical 
use  are  given  in  Appendix  B. 


27 


CHAPTER  III 

THE  INCREASE  IN  CANCER 

Early  Mortality  from  Cancer  in  London — Causes  of  Local  Variations — Argument  by 
King  and  5s"ewsholme — Statistics  of  Frankfurt  a/M. — Increase  in  Cancer  by  Organs 
and  Parts — Utility  of  a  Cancer  Census — Cancer  among  Primitive  Races — Statistical 
Problems  of  Erroneous  Diagnosis — Evidence  of  Cancer  Increase  throughout  the 
World — [Misleading  Statistical  Observations — Useless  Controversies — Trustworthi- 
ness of  American  Mortality  Statistics — Contributory  Causes  of  Death  in  Cancer — 
Continued  Increase  in  Cancer  Frequency — Public  Menace  of  Ignorance  and 
Indifference. 

The  question  whether  cancer  is  on  the  increase  is  one  of  the  most 
important  problems  in  modern  medicine.  If  cancerous  complaints 
are  actually  and  relatively  more  frequent  at  the  present  time  than  in 
former  years,  it  is  self-e\ddent  that  the  underlying  causes  or  conditioning 
circumstances  must  be  of  recent  development  and  the  result  of  changed 
methods  of  living  or  of  profound  modifications  in  the  human  environ- 
ment. If  cancer  is  not  on  the  increase,  but  is  actually  a  much  more 
common  disease  than  was  generally  assumed  to  be  the  case  in  the  past, 
because  of  misleading  statistics  or  superficial  and  imperfect  diagnosis, 
then  the  more  trustworthy  returns  for  the  present  period  serve  the  ex- 
tremely practical  purpose  of  emphasizing  the  serious  menace  of  cancer 
and  the  supreme  importance  of  more  qualified  medical  and  surgical 
consideration  of  the  subject.  For  it  is  self-e^ddent  that  if  the  charge  is 
true  that  in  the  past  a  large  number  of  deaths  have  been  erroneously 
recorded  as  due  to  other  causes  than  cancer,  when,  in  fact,  such  deaths 
were  due  to  cancerous  complaints,  the  medical  and  surgical  profession 
must  have  been  grossly  derelict  in  its  duty  and  inconceivably  incom- 
petent, considering  the  high  degree  of  attained  proficiency  in  other 
branches  of  medicine  and  surgery.  There  are  the  strongest  possible 
reasons  for  belie%ang,  however,  that  this  lamentable  conclusion,  which 
would  be  virtually  equivalent  to  a  charge  of  gross  malpractice  against 
the  world's  medical  profession,  is  not  true.  Those  who  maintain  that 
cancer  is  not  on  the  increase,  but  that  the  higher  recorded  rate  of 
frequency  at  the  present  time  is  but  an  evidence  of  erroneous  diagnosis 
or  wrongful  classification  in  the  past,  can  not  be  aware  of  the  far-reach- 
ing significance  of  their  conclusions  when  concretely  applied  to  the 
cancer  problem.  For  illustration,  in  the  registration  area  of  the  United 
States,  during  the  decade  ending  with  the  year  1913,  the  recorded  can- 
cer death  rate  increased  from  70.2  to  78.9.  When  these  rates  are  applied 
to  the  population  of  the  continental  United  States  as  a  whole,  it  appears 
that  during  this  period  there  were  658,139  deaths  from  cancer.  If, 
however,  the  rate  for  all  the  years  previous  to  1913  was  deficient  in  ac- 
curacy, and  if,  in  fact,  the  rate  for  that  year,  given  as  78.9,  had  actually 
prevailed  during  each  of  the  previous  years,  there  would  have  been 
706,752  deaths  from  cancer,  or  a  difference  of  48,613.  It  would  seem 
utterly  inconceivable  that  this  number  of  cancer  deaths  should  have  oc- 
curred in  the  United  States  during  a  single  decade  and  been  erroneously 

28 


THE  INCREASE  IN  CANCER 

diagnosed  as  due  to  some  other  disease  than  cancer.  During  recent  years, 
however,  the  cancer  death  rate  has  not  increased  quite  as  rapidly  as 
during  earher  periods,  and  the  contrast  would  therefore  be  much  more 
marked  if  the  actual  effect  of  the  assumed  errors  in  registration  and 
diagnosis  were  calculated  for  a  longer  period  of  time. 

No  one  familiar  with  the  facts  can  question  the  view  that  many 
years  ago  cancers  of  the  internal  organs  were  quite  frequently  diag- 
nosed in  error,  or  in  any  event  classified  superficially  under  some  other 
term.  Walshe,  in  his  treatise  on  "Cancer,"  published  in  1844,  took 
occasion  to  point  out  that  the  mortality  attributed  to  cancer  was  in  all 
probability  below  the  true  mark,  particularly  of  those  under  the  head  of 
diseases  of  the  generative  organs,  especially  of  the  uterus.     He  remarks : 

A  large  proportion  was  in  all  likelihood  caused  by  carcinoma;  the  same  is  true,  though 
to  a  less  degree,  of  fatal  cases  of  organic  disease  of  the  intestinal  canal  and  of  "stricture  of 
the  rectum  and  oesophagus"  in  persons  of  advanced  age. 

Whether  the  frequency  of  cancerous  disease  is  on  the  increase  is  a  question  of  consider- 
able interest,  but  one  to  which  we  cannot  unfortunately  furnish  any  very  satisfactory  reply, 
as  we  have  not  the  means  of  ascertaining  the  proportion  of  the  population  annually  cut 
off  by  the  disease  during  a  series  of  years.  The  only  statistical  facts  we  can  find  bearing 
on  this  question  are  given  in  the  following  table,  showing  the  ratio  of  cancerous  deaths  to 
the  total  mortality  of  the  metropolis  during  the  last  century. 

Mortality  from  Cancer  in  London,  1728-1838 

Proportion  of  Deaths 
Time  from  Cancer  in  Every 

1,000  Deaths 

From  1728-1757  (SOyears) 2.0 

From  1771-1780  (lOyears) 3.4 

From  1831-1835  (5 years) 4.4* 

From  June  31, 1837,  to  December  31, 1838  (18  months)!-  ..6.1 

In  commenting  on  this  table,  Walshe  points  out  that 

From  this  it  would,  on  first  view,  appear  that  the  frequency  of  the  disease  has  been 
steadily  increasing  during  the  last  100  years;  but  the  real  causes  of  the  augmented  ratio 
are  more  likely  to  be  the  decrease  of  mortality  from  epidemic  diseases,  and  the  greater 
accuracy  of  diagnosis,  as  respects  carcinomatous  affections.  We  must  wait  for  correct 
answers  to  questions  of  this  high  import,  until  the  present  Registratica  Act  has  been  in 
operation  for  a  series  of  years. 

It  would  not  serve  a  practical  purpose  to  inquire  too  far  back  into  the 
earlier  records  of  cancer  mortality,  which  for  self-evident  reasons  must 
have  been  less  trustworthy  and  conclusive  than  those  derived  from 
official  registration  returns. |  It  would  also  be  misleading  to  determine 
the  increase  in  cancer  mortality  on  the  basis  of  a  proportion  to  the  mor- 
tality from  all  causes,  although  under  given  conditions  this  method  may 
yield  fairly  satisfactory  results.  The  extract  from  the  work  by  Walshe 
is  merely  included  as  evidence  that  even  seventy  years  ago  the  question 
of  cancer  increase  was  receiving  critical  attention  and  that  the  same  con- 
clusion was  then  advanced  as  now:  that  the  increase  was  more  apparent 
than  real  and  due  primarily  to  improved  diagnosis. 

*These  three  proportional  numbers  are  taken  from  a  table  calculated  by  Dr.  Farr,  and  given  at  page  577  of 
his  "Vital  Statistics." 

fThe  absolute  number  of  deaths  from  cancer  registered  in  the  metropolis  during  this  period  was  470,  bring- 
ing cancer  from  a  position  of  almost  no  importance  to  that  of  a  predominating  cause  of  death. 

JAmong  the  earliest  mortality  statistics  by  causes  are  the  returns  for  the  Jews  of  the  Vienna  Ghetto, 
1648-69,  discussed  by  Dr.  Schwarz  in  the  periodical  on  the  Demography  and  Statistics  of  the  Jews,  April, 
1910.  According  to  this  writer,  out  of  883  medically  or  otherwise  certified  causes  of  death  among  the  Jews 
of  Vienna  during  the  period  1648-6S,  only  one  death  was  due  to  cancer.      (See  note  on  page  23.) 


THE  MORTALITY  FROM  CANCER 

Causes  of  Local  Variations 
It  is  a  practical  certainty,  however,  that  this  argument  can  be  carried 
too  far,  A  point  must  be  reached,  sooner  or  later,  where  the  margin 
of  error  is  reduced  to  relatively  unimportant  proportions.  A  definite 
maximum  figure  in  cancer  mortality,  however,  can  not  be  said  to  exist. 
There  is  an  enormous  range  in  cancer  frequency  from  the  almost 
complete  absence  of  the  disease  to  its  being  one  of  the  principal 
causes  of  death  in  adult  life.  A  maximum  point  of  normal  fre- 
quency must,  of  course,  be  reached  in  time,  particularly  in  the  case 
of  long-settled  and  densely  populated  countries.  Such  a  maximum 
rate,  however,  would  not  by  any  means  indicate  errors  or  defects  in  low 
prevailing  rates  for  other  countries.  "Cancer,"  like  "fevers,"  is  an  indefi- 
nite term  and  comprehends  affections  due  probably  to  the  same  causes  or 
conditioning  circumstances,  but  with  fundamentally  different  results  as 
regards  the  organs  or  parts  of  the  body  affected.  An  excessive  cancer 
death  rate  in  one  country  may  be  largely  due  to  a  high  mortality 
from  cancer  of  the  stomach  among  males;  in  another  country,  the 
excess  in  the  cancer  death  rate  may  be  chiefly  due  to  a  high  degree  of 
frequency  of  cancer  of  the  uterus  or  of  the  female  breast.  Certain  forms 
of  cancer  prevail  in  some  regions  of  the  globe  which  are  practically  un- 
known in  others :  the  so-called  Kangri  cancer  of  Kashmir,  for  illustration, 
is  not  met  with  among  civilized  mankind.*  Cancer  of  the  cheek,  caused 
apparently  by  slow  irritation  following  the  chewing  of  the  betel  nut  by 
the  women  of  India,  is  very  rare  among  Europeans.  It  is  therefore  an 
entirely  safe  conclusion  that  gastric  cancers  or  uterine  cancers,  which 
are  excessively  common  among  civilized  races,  may  be  actually  very  rare 
among,  but  not  completely  absent  from,  native  races,  existing  under 
fundamentally  different  conditions  of  life.  The  more  thoroughly  the 
geographical  distribution  of  cancer  is  studied,  particularly  with  regard 
to  the  local  incidence,  according  to  organs  and  parts  of  the  body  affected, 
the  more  definite  is  the  conclusion  that  observed  variations  in  cancer  fre- 
quency are  real  and  not  apparent;  that  they  are  the  evidence  of  a 
greater  or  less  susceptibility  to  various  forms  of  malignant  disease  and 
not  primarily  or  exclusively  the  result  of  incompetence,  carelessness  or 
indifference  in  medical  diagnosis. 

The  Argument  by  King  and  Newsholme 

One  of  the  most  important  contributions  to  the  question  of  cancer  in- 
crease is  the  classical  essay  on  "The  Alleged  Increase  of  Cancer,"  by  King 
and  Newsholme,  originally  read  before  the  Royal  Society  on  May  4, 1893. 
The  paper  includes  an  interesting  review  of  the  earlier  statistics  of  cancer 
in  England  and  Wales  and  the  observations  of  the  Registrar-General 
on  the  apparent  increase  in  the  mortality  rate.  The  experience  data  of 
certain  insurance  companies  were  utilized,  but  only  to  rather  limited 
advantage.  The  main  reliance  of  the  authors  was  upon  statistics  of  the 
city  of  Frankfurt  a/M.,  Germany,  which  differentiate  certain  forms  of 
accessible  and  inaccessible  cancers,  it  being  stated  that  "under  accessible 
cancers  we  have  included  only  four  headings :  tongue,  mammae,  uterus 

*For  a  descriptive  account  of  Kangri  cancer,  by  Ernest  F.  Neve,  M.  D.,  with  illustrations,  see  The  British 
MedicalJournal,  September  3,  1910, 

30 


THE  INCREASE  IN  CANCER 

and  vagina,  all  of  which  are  capable  of  careful  and  exact  diagnosis."* 
This  point  of  view,  however,  must  be  seriously  questioned;  for  it  is 
quite  doubtful  whether  all  uterine  or  even  vaginal  cancers  can  be 
accurately  diagnosed  as  such  without  an  exploratory  operation  or  a 
microscopical  examination  of  the  diseased  parts.  Under  "inaccessible" 
cancers,  the  authors,  on  the  basis  of  the  Frankfurt  data,  considered  all 
other  forms  than  those  mentioned.  Now,  obviously,  a  fair  proportion  of 
deaths  from  cancer  are  those  of  the  skin,  other  parts  of  the  mouth  than 
the  tongue,  and  other  external  parts  of  the  body,  which  being  included 
among  the  inaccessible  cancers  must,  to  a  certain  extent  at  least,  have 
affected  the  accuracy  of  the  conclusions.  A  more  useful  classification 
of  accessible,  intermediate  and  inaccessible  cancers,  is  given  by  Bash- 
ford  in  the  Report  of  the  Imperial  Cancer  Research  Fund  on  "The 
Statistical  Investigation  of  Cancer,"  previously  referred  to.f  Attention 
was  drawn  to  the  fact  that  the  cancer  death  rate  of  Frankfurt  was  quite 
considerably  in  excess  of  the  corresponding  rate  of  the  United  King- 
dom, but  no  satisfactory  explanation  could  be  offered  for  this  difference 
except  the  extremely  careful  death  certification  in  use  in  this  German 
city.  To  compare  the  rate  of  a  country  with  that  of  a  city  is  in  it- 
self quite  apt  to  be  misleading.  For  the  five-year  period  ending 
with  1910,  the  cancer  death  rate  for  London,  combining  both  sexes, 
was  111.0,  against  a  corresponding  cancer  death  rate  of  96.2  for  Frank- 
furt. The  difference  on  the  basis  of  a  more  correct  comparison  was 
therefore  indicative  of  a  higher  cancer  prevalence  in  the  capital  city 
of  England  when  compared  with  one  of  the  large  cities  of  Germany. 
The  main  contention  of  Messrs.  King  and  Newsholme,  on  the  basis  of 
the  Frankfurt  data,  was  that  the  apparent  increase  in  cancer  was 
practically  limited  to  the  occurrence  of  this  disease  in  the  internal  or 
inaccessible  organs,  or,  in  their  own  words:  "Taking  a  general  view 
of  the  Frankfurt  figures  the  one  result  of  surpassing  importance 
to  be  derived  from  them  is  that  in  those  parts  of  the  body  in  which 
cancer  is  easily  accessible  and  detected  there  has  been  no  increase  in 
the  mortality  from  it  between  1860  and  1889," 

Recent  Cancer  Statistics  of  Frankfurt  a/M. 

For  reasons  unknown,  the  authors  have  not  considered  it  necessary  to 
reexamine  into  the  facts  during  the  long  intervening  period  of  time.  The 
Frankfurt  data  are  by  no  means  the  most  useful  or  conclusive  information 
for  a  scientific  study  of  cancer  statistics;  in  fact,  the  classification  fails 
to  conform  to  modern  requirements,  in  that  it  is  not  in  accordance  with 
the  International  Classification  of  Causes  of  Death,  f     In  view  of  the 

*The  problem  of  cancer  increase  with  special  reference  to  the  Frankfurt  data  has  recently  been  discussed 
by  Prof.  Walter  F.  Willcox  in  an  address  before  the  American  Public  Health  Association  at  the  Jack- 
sonville meeting,  1914.  The  paper  presents  the  results  of  an  original  study  of  the  Frankfurt  statistics  since 
1865,  but  unfortunately  the  King-Newsholme  classification  of  internal  and  external  cancers  is  retained,  so  that 
the  conclusions  can  not  be  considered  final.     (See  also  discussion  on  pages  83-90.) 

tThe  title  of  this  publication  is  "Scientific  Reports  on  the  Investigations  of  the  Imperial  Cancer  Research 
Fund,"  Part  1,  Statistical  Investigation  of  Cancer,  London,  1905.     (See  Table  8,  Appendix  A.) 

IThe  conclusiveness  of  the  Frankfurt  data  is  very  much  exaggerated.  The  population  of  Frankfurt  is 
only  438,000  and  a  considerable  proportion  are  Jews.  The  city  hospitals  are  made  much  use  of  by 
strangers,  and  it  is  not  entirely  clear  whether  correction  has  been  made  for  this  factor.  In  view  of  the 
extremely  complex  nature  of  the  cancer  problem  the  statistics  for  any  given  community,  however  large  or 
however  extended  in  point  of  time,  are  only  of  limited  utility.     They  are  useful,  but  not  finally  conclusive. 

31 


THE  MORTALITY  FROM  CANCER 

value  frequently  attached  to  the  conclusions  on  the  basis  of  the  Frank- 
furt data,  the  more  recent  statistics  have  been  brought  together,  as  given 
in  the  official  reports  made  annually  by  the  Frankfurt  Medical  Society. 
The  follo^^dng  table  exhibits  the  comparative  mortality  by  organs  and 
parts,  for  two  periods,  ending  respectively  with  1909  and  1913. 

Mortality  from  Cancer  in  Frankfurt  a/M.,  by  Organs  and  Parts  of  the  Body 
according  to  Sex,  1906-1909  and  1910-1913 


MALES 


Organ  or  Part 

Skin 

Digestive  organs 

Respiratory  organs 

Urinary  organs 

Generative  organs 

Other  carcinoma 

Sarcoma 

Other  malignant  tumors . 


Deaths  from  Cancer 
1906-09         1910-13 


3 

470 
32 
21 
6 
25 
28 
23 


Total i    608 


6 

540 

23 

27 

8 
29 
35 
46 

714 


Rate  per 

100,000  Population 

1906-09  1910-13 

0.4 
68.5 
4.7 
3.1 
0.9 
3.6 
4.1 
3.3 


88.6 


98.2 


Per  Cent,  of 
Increase 


0.8 

4-100.0 

74.2 

-f8.3 

3.2 

—31  9 

3.7 

+  19.4 

1.1 

+  22.2 

4.0 

+  11.1 

4.8 

+  17.1 

6.4 

+  93.9 

+  10.8 


FEMALES 


Organ  or  Part 

Skin 

Digestive  organs 

Respiratory  organs 

Urinary  organs 

Generative  organs 

Other  carcinoma 

Sarcoma 

Other  malignant  tumors. 

Total 


Deaths  from  Cancer 
1906-09        1910-13 


12 

447 

25 

5 

244 

76 

26 

24 

859 


500 
17 
20 

288 
80 
30 

48 

991 


Rate  per 
100,000  Population 
1906-09  1910-13 


1.5 

54.4 

3.0 

0.6 

29.7 
9.2 
3.2 
2.9 


0.9 

57.2 
1.9 
2.3 

33.0 
9.2 
3.4 
5.6 


104.5       113.5 


Per  Cent,  of 
Increase 

-^0.0 

+  5.1 

—36.7 

+  283.3 

+  11.1 

0.0 

+  6.3 

+93.1 

+  8.6 


Conclusions  Opposed  to  Experience 

This  table  is  exceptionally  instructive,  in  that  the  general  cancer 
death  rate  is  shown  to  have  increased  during  the  last  period,  compared 
with  the  first,  from  88.6  to  98.2  for  males  and  from^  104.5  to  113.5  for 
females.  Accepting  the  view  that  death  certification  in  Frankfurt^  is 
considered  satisfactory  and  complete  the  conclusion  would  seem  in- 
controvertible that  there  has  been  an  actual  as  well  as  a  relative 
increase  in  cancer  mortality  in  Frankfurt  of  10.8  per  cent,  for  males 
and  8.6  per  cent,  for  females.  Considered  by  organs  and  parts,  on 
the  basis  of  a  rather  unsatisfactory  classification,  it  appears  that 
among  males  the  mortality  from  cancer  increased  in  every  group 
excepting    cancers    of    the    respiratory    organs,    which    are    relatively 

32 


THE  INCREASE  IN  CANCER 

unimportant.  Cancer  of  the  skin  doubled  in  frequency;  cancer  of  the 
digestive  organs  increased  8.3  per  cent.,  but  the  earher  rate  for  this  group 
is  distinctly  excessive,  and  a  maximum  figure  has  possibly  been 
reached.  Among  females,  cancer  of  the  respiratory  organs  and  of 
the  sldn  decreased,  but  all  the  other  groups  increased,  including  cancer 
of  the  generative  organs,  which,  according  to  Messrs.  King  and  News- 
holme,  were  among  those  classified  as  accessible.  The  most  recent  data 
for  Frankfurt,  therefore,  do  not  confirm  the  earlier  conclusion  that 
the  increase  in  cancer  was  only  apparent  and  not  real.* 

An  important  discussion  as  regards  the  alleged  increase  in  cancer  on  the 
basis  of  German  insurance  experience  occurs  in  the  Proceedings  of  the 
German  Society  for  Insurance  Science,  f  In  this  discussion  it  is 
emphatically  denied  by  the  Medical  Director  of  the  Gotha  that  the 
observed  increase  in  cancer  mortality  was  the  result  of  improved 
diagnosis.  He  points  out  that  even  in  the  '80s  and  '90s  cancer  diag- 
nosis was  sufficiently  well  developed  to  provide  reasonable  accuracy  in 
death  certification.  The  same  authority  concludes  that  in  only  nine 
per  cent,  of  the  mortality  from  cancer  in  the  company's  experience  was 
there  a  previous  record  of  cancer  in  the  family  history. 

Increase  in  Cancer,  by  Organs  and  Parts 

There  are  some  additional  data  extant  regarding  this  aspect  of  the 
cancer  problem,  which  may  be  briefly  referred  to  here.  For  England 
and  Wales  the  data  are  available  for  the  two  periods  1897-1900  and 
1901-10.  The  mortality  of  males  from  cancer  of  accessible  organs  in- 
creased 27.4  per  cent.,  against  22.2  per  cent,  for  the  inaccessible  organs 
and  the  undefined  group  decreased  24.0  per  cent.  Among  females  the 
mortality  from  cancer  of  accessible  organs  increased  16.7  per  cent.,  or, 
including  cancer  of  the  uterus,  9.9  per  cent.;  cancer  of  the  inaccessible 
organs  increased  16.6  per  cent.,  and  cancer  of  the  undefined  group  de- 
creased 32.1  per  cent.  The  English  statistics  of  recent  years  are,  there- 
fore, also  in  flat  contradiction  of  the  conclusions  based  upon  the  earlier 
Frankfurt  data.  The  details  for  England  and  Wales,  according  to  organs 
and  sex,  are  given  in  Tables  10  to  13,  inclusive,  of  Appendix  G.| 

For  Bavaria  the  data  are  available  for  the  two  periods  1905-07  and 
1905-10.  Among  males,  cancer  of  the  accessible  organs  increased  25.5 
per  cent.;  of  the  inaccessible  organs,  5.2  per  cent.;  and  of  the  undefined 
group,  4.4  per  cent.  Among  females,  cancer  of  the  accessible  organs 
increased  15.6  per  cent.,  or,  including  cancer  of  the  uterus,  8.3  per  cent.: 
cancer  of  the  inaccessible  organs  increased  4.8  per  cent.,  and  cancer 
of  the  undefined  group,  4.3  per  cent.  The  statistics  for  Bavaria,  there- 
fore, also  confirm  the  conclusion  that  the  observed  increase  in  the  cancer 
death  rate  represents  a  real  increase,  being  found  to  have  occurred  chiefly 

•See  in  this  connection  reference  to  a  recent  discussion  of  the  Frankfurt  data  on  page  46. 

fZeitschrift  fiir  die  gesamte  Versicherungs-Wissenschaft,  Berlin,  1912,  Vol.  xii,  p.  309. 

tWhen  comparing  the  cancer  mortality  of  England  and  Wales  for  1901-10  with  1911-12,  it  appears  that 
the  male  cancer  death  rate  has  increased  16.9  per  cent.;  the  increase  in  the  rate  for  accessible  organs  is  25  per 
cent.;  for  iiiaca;ssible  organs,  18.1  per  cent.;  the  undefined  group  shows  a  decrease  of  5.1  per  cent.  The  female 
cancer  death  rate  has  increased  7.5  per  cent.;  the  rate  has  increased  12.1  per  cent,  for  accessible  organs,  exclud- 
ing the  uterus,  and  14.4  per  cent,  for  inaccessible  organs.  Cancer  of  the  uterus  shows  a  decrease  of  8.9  per  cent., 
and  the  undefined  group  a  decrease  of  3.1  per  cent. 

33 


THE  MORTALITY  FROM  CANCER 

in  the  group  of  cancers  conveniently  accessible  for  the  purposes  of  medical 
and  surgical  diagnosis.  Of  course,  the  variations  in  the  rate  of  increase 
of  the  different  forms  of  cancer  are  of  considerable  importance ;  but  they 
do  not  require  discussion,  being  fully  disclosed  by  the  tables  giving  the 
necessary  details.  The  data  for  Bavaria  are  given  in  Tables  93  to  95 
of  Appendix  G.* 

The  conclusions  of  Messrs.  King  and  Newsholme  were  strongly  opposed 
in  an  address  on  the  "Increase  in  Cancer,"  delivered  by  J.  F.  Payne  on 
October  12,  1898,  before  the  Hunterian  Society.  In  1899  the  subject 
was  further  discussed  by  J.  H.  Richardson,  F.  F,  A.,  in  an  address  before 
the  Insurance  Institute  of  New  Zealand  on  "Phthisis  and  Cancer," 
and  in  1901,  before  the  Institute  of  Actuaries,  London,  Richard  Teece, 
actuary  of  the  Australian  Mutual  Provident  Society,  reconsidered  the 
then  available  material,  which  was  followed  by  a  discussion  participated 
in  by  Dr.  Payne,  Dr.  Glover  Lyon,  Dr.  H.  Fox,  Mr.  George  King  and 
Dr.  Arthur  Newsholme.  The  discussion  did  not  prove  or  disprove 
successfully  either  contention,  largely  because  the  new  material  re- 
quired for  consideration  was  not  then  available  for  critical  analysis. 

Statistical  Inquiries  of  the  Imperial  Cancer  Research  Fund 

The  next  important  contribution  to  the  statistical  study  of  the  prob- 
lem of  cancer  increase  was  a  brief  report  published  by  the  authority 
of  the  Executive  Committee  of  the  Imperial  Cancer  Research  Fund  in 
1905.  The  joint  authors  of  this  report  were  Dr.  E.  F.  Bashford  and  Dr. 
J.  A.  Murray.  The  conclusions,  however,  had  no  doubt  been  con- 
sidered by  the  members  of  the  Sub-Committee  of  the  Society,  including 
Dr.  J.  F.  Tatham,  then  Registrar-General,  and  Dr.  Arthur  Newsholme. 
The  report  includes  a  brief  discussion  of  the  inherent  limitations  of 
statistical  investigations  of  cancer,  of  the  fallacies  apparently  inherent 
in  a  cancer  census,  the  importance  of  age  incidence  in  cancer,  the  bearing 
of  the  provisional  results  of  the  statistical  study  of  the  Fund  upon  the 
question  of  the  alleged  increase  of  cancer,  and,  finally,  important  obser- 
vations on  the  frequency  with  which  microscopical  examinations,  in  the 
cases  of  carcinoma  and  sarcoma, f  were  made  in  operative  cases  and  on 
post-mortem  cases,  indicating  the  presence  of  conditions  leading  to  the 
wrong  diagnosis  of  malignant  new  growths.  The  report  contains  many 
observations  and  conclusions  to  which,  from  a  statistical  point  of  view,  it 
is  necessary  to  take  exception.  The  report  of  1905  has  not  been  followed 
by  any  further  publications  of  a  similar  nature  by  the  Imperial  Cancer 
Research  Fund.  An  extended  critical  review  of  the  report  would  make  a 
useful  contribution  to  the  cancer  problem. { 

•Bericht  ueber  das  Bayerisches  Gesundheitswesen,  Munchen,  1912. 

tThe  following  concise  definitions  of  carcinoma  and  sarcoma  are  from  the  second  edition  of  Gould  and  Pyle's 
Pocket  Cyclopedia  of  Medicine  and  Surgery,  Philadelphia,  1914. 

"Carcinoma. — A  malignant  tumor  characterized  by  a  network  of  connective  tissue  the  areolas  of  which  are 
filled  with  cell  masses  resembling  epithelial  cells." 

"Sarcoma. — A  connective-tissue  tumor  in  which  the  cells  so  predominate  in  number,  and  often  in  size,  that 
the  intercellular  substance  becomes  a  secondary  element.  Sarcomata  are  maglignant  tumors  and  appear  at  an 
earlier  age  than  carcinoma.  They  are  made  up  of  embryonal  connective  tissue  and  are  of  three  varieties:  the 
round-cell,  the  spindle-cell,  and  the  giant-cell  sarcoma.  They  may  exist  alone  or  in  combination  with  other 
tumors." 

tSee  in  this  connection  The  Lancet,  February  7,  1914,  and  April  11,  1914,  containing  correspondence  on 
the  Accuracy  of  American  Vital  Statistics,  with  special  reference  to  cancer. 

34 


THE  INCREASE  IN  CANCER 

Utility  of  a  Cancer  Census 

It  may  be  laid  down  as  a  first  prerequisite  of  statistical  research  that 
the  data  relied  upon  shall  be  sufficient  in  extent  and  period  of  time  to 
provide  a  basis  for  accurate  and  safe  conclusions.  The  report  of  the 
Imperial  Cancer  Research  Fund  considers  a  large  variety  of  subjects, 
all  of  more  or  less  importance  in  their  relation  to  the  statistical  aspects 
of  the  cancer  problem.  The  practical  utility  of  a  cancer  census  is  con- 
sidered at  some  length,  but  the  conclusions  arrived  at  are  decidedly 
adverse  to  such  investigations.  It  is  maintained  that  a  cancer  census 
depends,  first,  upon  the  adequate  identification  of  all  cancer  cases  and 
secondly,  upon  the  existence  of  a  standard  population  in  which  these  cases 
arise.  Neither  of  these  requirements  can  be  met  in  any  statistical 
inquiry  of  this  kind.  Under  no  conceivable  circumstances  could  any 
scientific  investigation  determine  the  total  existing  amount  of  cancer- 
ous affections  in  the  entire  population,  from  cases  in  the  very  initial 
stages  to  cases  in  the  most  advanced.  As  a  practical  compromise  all  such 
investigations  are  properly  limited  to  the  cancer  cases  under  medical  ob- 
servation, as  being  fully  sufficient  for  the  purpose  of  study  and  compari- 
son. Dr.  Bashford  in  this  connection  insists  upon  a  standard  population; 
but  a  standard  population  is  simply  a  statistical  assumption  and  an 
expedient  to  facilitate  the  comparison  of  otherwise  varying  population 
factors.  A  population  of  any  normal  country  may  be  assumed  as  a 
standard,  provided  the  populations  of  the  other  countries  are  reduced  to 
the  same  basis  of  age  and  sex  distribution.* 

The  authors  of  the  report  use  the  term  "actuarial  statistics,"  which 
is  also  misleading.  Actuarial  statistics,  properly  speaking,  are  those  of 
life  insurance  companies,  having  to  do  with  mortality  experience  and 
valuation  methods,  or,  in  other  words,  the  practical  application  of  the 
science  of  life  contingencies  to  the  business  requirements  of  insurance 
institutions.  Such  statistics  are  not  necessary  or  useful  in  connection 
with  cancer  mortality  investigations,  although  it  is  entirely  proper  and, 
in  fact,  highly  desirable  that  actuarial  methods  should,  under  given  con- 
ditions, be  applied  to  the  statistical  consideration  of  certain  special 
phases  of  the  cancer  problem. 

Dr.  Bashford,  in  the  report  referred  to,  maintains  that  "there  is 
nothing  in  the  statistical  investigations  of  the  Imperial  Cancer  Re- 
search Fund  which  points  to  an  actual  increase  in  the  death  rate  from 
cancer."  Such  an  important  and  far-reaching  conclusion  should  be 
substantiated  by  indisputable  and  incontrovertible,  as  well  as  a  sufficient 
amount  of,  statistical  evidence.  No  such  evidence  is  presented  in  the 
report  for  1905.  The  further  conclusion  that  "it  is  not  possible  to 
determine  statistically  whether  cancer  is  really  increasing  as  the  increase 
in  the  recorded  cases  would  imply"  is  also  not  sustained  by  the  facts 
available,  nor  justified  when  conservative  and  trustworthy  methods 
are  employed  in  the  statistical  study  of  the  cancer  problem.  The 
present  work  is  intended  to  meet  this  requirement  and  to  furnish  the 
necessary  statistical  evidence  for  a  scientific  study  of  the  cancer  problem 
from  the  statistical  point  of  view. 

*A  cancer  census  is  being  undertaken  by  the  State  Medical  Society  of  Wisconsin,  but  unfortunately  upon  the 
basis  of  a  blank  which  is  not  likely  to  jneld  all  of  the  required  information.  A  more  elaborate  cancer  census 
is  contemplated  by  the  Michigan  State  Board  of  Health. 

35 


THE  MORTALITY  FROM  CANCER 

Cancer  among  Primitive  Races 
There  are  many  other  conclusions  and  observations  in  the  Report  of 
the  Imperial  Cancer  Research  Fund  on  the  statistical  investigation  of 
cancer  which  do  not  stand  the  test  of  impartial  consideration.  The 
argument,  for  illustration,  that  "the  relative  frequency  of  cancer  in 
native  races  cannot  yet  be  even  approximately  estimated"  is  not 
sustained  by  the  many  investigations  which  have  been  made  by  quali- 
fied medical  observers,  with  an  extended  practice  among  native  races 
throughout  the  uncivilized  portions  of  the  world.  *  It  is  self-evident 
that  the  information  regarding  cancer  frequency  in  native  races  can 
not  be  considered  of  equal  value  with  the  returns  for  civilized  countries ; 
but  it  is  necessary  to  refer  only  to  such  a  painstaking  study  as 
has  been  made  of  the  spread  of  cancer  among  the  descendants  of 
hberated  Africans  or  Creoles  by  Dr.  W.  Renner,  published  in  the  annual 
report  of  the  Sierra  Leone  Medical  Department  for  the  year  ending 
December  31,  1909,  to  contradict  the  statement  that  the  relative  fre- 
quency of  cancer  among  native  races  "cannot  yet  be  even  approxi- 
mately estimated."! 

Cancer  Census  of  Baden 

The  practical  utility  of  cancer  census  investigations  is  unquestionably 
rather  limited;  but  qualified  opinion,  certainly  on  the  continent  of 
Europe,  seems  to  faA'or  inquiries  of  this  kind.  The  Cancer  Census  of 
Baden  and  Hungarj^  in  particular,  may  be  referred  to  as  useful  and 
instructive  studies,  the  results  of  which  are  fully  commensurate  with  the 
labor  and  expense  necessary  to  collect  the  facts.  The  value  of  such 
investigations  is  enhanced  by  the  intelligent  correlation  of  cancer  mor- 
tality data.  In  any  event,  so  important  a  question  as  the  value  of  a 
cancer  census  can  be  settled  only  by  means  of  a  thoroughly  critical  and 
qualified  analysis  of  the  facts,  which,  it  may  be  said,  has  not  been  made, 
or  at  least  has  not  thus  far  been  published,  by  the  Imperial  Cancer  Re- 
search Fund.  The  cancer  census  of  Baden,  published  in  1910,  is  an 
exceptionally  valuable  illustration  of  the  methods  of  statistical  inquiry  to 
be  followed  in  local  cancer  research.  The  investigation  includes  a  study 
of  the  geographical  distribution  of  cancer  according  to  age  and  sex 
throughout  the  Grand  Duchy  of  Baden,  the  frequency  of  deaths  from 
sarcoma,  the  influence  of  season,  occupation,  etc.,  and  the  geographical 
distribution  by  small  subdivisions  of  territory,  such  as  in  this  country 
would  correspond  to  townships.  This  analysis  of  the  mortality  covers 
the  period  1883-1907,  and  the  variations  in  the  rate  by  single  years, 
are  illustrated  by  maps  and  diagrams  of  exceptional  clearness.  The  argu- 
ment is  advanced  that  the  results  of  such  an  inquiry  would  be  materi- 
ally improved  if  the  notification  of  cancer  cases  were  made  compulsory. 
The  occasional  disparity  in  the  number  of  cases  reported  to  the  cancer 
committee,  in  contrast  with  the  observed  mortality,  is  explained  on  the 

*For  much  interesting  and  useful  information  regarding  cancer  among  native  races,  see  three  reports  pub- 
lished by  the  Colonial  OfiBce  containing  the  correspondence  on  the  Imperial  Cancer  Research  Scheme,  London, 
(1905,  1906,  1908)  and  also  the  discussion  on  "The  Ethnological  Distribution  of  Cancer,"  by  E.  F.  Bashford, 
in  the  Third  Scientific  Report  of  the  Imperial  Cancer  Research  Fund,  London,  1908. 

There  are  numerous  special  reports  on  cancer  occurrence  among  primitive  races  in  the  volumes  of  the 
German  Journal  for  Cancer  Research  (Zeitschrift  fur  Krebsforschung,  1903-13). 

tSee  in  this  connection  the  discourse  on  the  geographical  distribution  of  appendicitis  by  R.  W.  Murray 
in  The  Lancet,  July  25,  1914. 

36 


THE  INCREASE  IN  CANCER 

ground  that  in  many  cases  the  full  cooperation  of  reporting  physicians 
was  not  obtained. 

Statistical  Problems  of  Erroneous  Diagnosis 
A  strictly  scientific  study  of  cancer  statistics  is  unquestionably  a  dif- 
ficult undertaking.  The  problems  involved  are  not  only  statistical  and 
mathematical,  but  the  medical,  anthropological  and  sociological  difficul- 
ties are  even  more  complex.  As  previously  pointed  out,  in  England 
and  Wales  during  the  last  fourteen  years  the  accessible  cancers  have 
increased  more  rapidly  than  the  inaccessible;  and  although  cancer 
of  the  breast  is  one  of  the  most  easily  recognized  forms,  the  death  rate 
of  this  group  of  cancers  is  distinctly  higher  now  than  in  former  years.* 
No  conclusive  answer  has  been  made  to  the  question  as  regards  the 
diseases  or  causes  to  which  deaths  from  cancer  may  have  been 
erroneously  assigned  on  the  basis  of  a  mistaken  diagnosis  or  an 
unscientific  method  of  classification.  There  is  no  evidence  that  the 
disease  groups  to  which  cancer  might  erroneously  have  been  assigned 
have  materially  decreased,  if  at  all,  coincident  with  the  gradual  rise 
in  the  cancer  death  rate.  Using  the  English  data,  as  perhaps  the 
most  conclusive,  it  may  first  be  said  that  there  can  be  only  com- 
paratively few  groups  of  diseases  or  causes  to  which  cancer  deaths 
could  be  erroneously  assigned;  for  obviously  this  could  not  be  the  case 
with  zymotic  diseases  and  accidents,  pregnancy,  infantile  diarrhoea, 
diseases  of  the  nervous,  circulatory  or  respiratory  system.  Some  of  these 
causes,  in  fact,  have  increased  in  recent  years;  and  this  is  also  true  of 
diseases  of  the  urinary  system.  The  first  suggestive  group  more  or  less 
related  to  cancer  is  that  of  gastritis,  gastric  ulcer  and  other  diseases  of 
the  stomach;  but  the  death  rate  of  this  group,  in  the  English  experi- 
ence, has  actually  increased  from  14.7  per  100,000  of  population  in 
1891  to  15.8  in  1910.  The  mortality  from  ulceration  of  the  intestines 
has  also  increased  from  1.2  per  100,000  of  population  to  2.4;  diseases  of 
the  liver  and  gall-bladder,  excluding  cirrhosis,  how^ever,  decreased  from 
16.3  per  100,000  of  population  to  5.3;  but  there  has  also  been  a  corre- 
sponding decrease  in  cirrhosis  of  the  liver,  so  that,  in  other  words,  all 
diseases  of  the  liver  are  apparently  decreasing.  Yet  this  is  a  group 
which  no  doubt  under  an  imperfect  classification  or  in  consequence 
of  an  erroneous  diagnosis  includes  some  deaths  from  cancer,  due  to  the 
fact  that  the  liver  is  occasionally  the  primary  seat  of  the  disease. 
Non-malignant  diseases  of  the  ovaries  and  the  uterus  have  decreased 
from  4.0  to  2.6;  but  since  cancer  of  the  uterus  in  England  is  rather 
stationary,  this  decrease  is  not  of  practical  importance.  Ulcers,  which 
are  an  ill-defined  group  and  most  likely  to  include  imperfectly  diag- 
nosed deaths  from  cancer,  decreased  from  1.8  to  1.3;  in  other  words, 
the  diminished  mortality  was  actually  and  relatively  of  no  practical 
importance.  Tumors  (not  specified)  diminished  from  a  very  low 
mortality  of  0.5  to  0.2;  and  abscesses,  also  an  insignificant  mortality 
factor,  diminished  from  1.8  to  0.7.  Granting  that  the  decrease 
in  some  of  these  causes  sustains  the  conclusion  that  the  diminu- 
tion is   the   result   of   more   accurate   diagnosis    or    classification    of 

*In  the  five  years  1903-07,  the  mortality  from  cancer  of  the  female  breast  per  100,000  of  population  in 
England  and  Wales  was  17.1;  during  the  period  1908-12,  the  rate  increased  to  18.6.  In  191'2  it  had  further 
increased  to  19.8. 

37 


THE  MORTALITY  FROM  CANCER 

cancer,  the  combined  effect  on  the  general  cancer  death  rate  would  not 
be  of  much  practical  significance.  Deaths  in  old  age,  which  might 
hide  a  considerable  proportion  of  deaths  from  cancer,  which  is  so 
exceptionally  a  disease  of  advanced  adult  life,  increased  from  94.2 
to  95.7.  Ill-defined  and  not-specified  causes  diminished  in  frequency 
from  9.3  to  2.3,  or  7.0  per  100,000  of  population,  during  the  twenty- 
year  period  under  review,  which,  of  course,  is  significant;  but  the 
decrease  since  1901,  or  during  the  last  decade,  has  been  only  2.2, 
whereas  there  has  been  an  increase  of  15.0  per  100,000  of  population 
in  the  cancer  death  rate  during  the  intervening  period  of  time.  The 
theory  of  an  improved  diagnosis  or  a  transfer  of  deaths  to  cancer  from 
other  groups  of  diseases  or  causes  is,  therefore,  not  tenable  as  a  general 
proposition  or  as  an  explanation  of  the  recorded  increase  in  the  cancer 
death  rate  of  England  and  Wales  during  the  last  twenty  years.*  With- 
out enlarging  upon  this  discussion,  it  may  be  said  that  deaths  from 
ulcer  of  the  stomach,  biliary  calculi,  and  calculi  of  the  urinary  tract, 
have  all  been  increasing,  and  some  of  these  rapidly  so,  in  the  registration 
area  of  the  United  States  during  the  period  1900-12,  and  to  this  extent 
the  conclusions  based  upon  other  data  are  confirmed. 

It  is  not  the  purpose  of  this  investigation  to  enlarge  upon  the 
statistical  aspects  of  any  particular  phase  of  the  cancer  problem,  for  in 
view  of  the  considerable  amount  of  material  brought  together,  such  an  ex- 
tended discussion  of  the  facts  would  be  impracticable.  The  tabular 
analysis  is  made  available  to  facilitate  an  extended  statistical  study  of  the 
cancer  problem,  but  certain  phases  of  the  same  are  taken  note  of  so 
far  as  the  facts  may  require  to  be  emphasized  or  explained. 

Conclusive  Evidence  of  Cancer  Increase 
In  the  foregoing  discussion  it  has  been  implied  that  cancer  is  on 
the  increase  practically  throughout  the  civilized  world.  It  is  main- 
tained that  this  increase  is  not  apparent,  but  real;  in  other  words, 
not  the  result  of  improved  diagnosis  or  more  scientific  classification 
or  of  a  changed  age  distribution.  Combining  the  returns  for  the 
United  Kingdom,  Norway,  Holland,  Prussia,  Baden,  Switzerland, 
Austria,  the  cities  of  Denmark,  the  Commonwealth  of  Australia 
and  the  Dominion  of  New  Zealand,  it  appears  that  these  countries 
in  1881  had  an  aggregate  population  of  98,380,000  and  44,047  deaths 
from  cancer,  equivalent  to  a  rate  of  44.8  per  100,000  of  population; 
by  1891  the  rate  had  increased  to  59.6,  by  1901  to  76.3,  and  by 
1911  to  90.4.  Thus,  during  thirty  years  the  cancer  death  rate  in 
these  countries,  which  are  typical  of  the  civilized  portion  of  the  world, 
has  more  than  doubled,  or,  to  be  exact,  the  rate  for  1911  was  101.8  per 
cent,  in  excess  of  the  rate  prevailing  in  1881.  In  1912  these  countries 
had  a  population  of  136,892,000  and  125,832  deaths  from  cancer,  equiva- 
lent to  a  rate  of  91.9.  If  the  cancer  death  rate  of  1881,  previously  given 
as  44.8,  had  prevailed  in  1912,  there  would  have  been  only  61,323  deaths 
from  cancer  instead  of  nearly  126,000;  if  the  cancer  death  rate  of  1912, 
previously  given  as  91.9,  had  prevailed  in  1881,  the  actual  number  of 

*The  increase  in  the  cancer  death  rate  of  England  and  Wales  has  continued,  and  the  most  recent  data 
are  as  follows:  the  average,  standardized,  cancer  death  rate  for  the  period  190(j-10  was  88.2  per  100,000  of 
population,  increasing  to  91.4  during  1911,  to  93.7  during  1912  and  to  97,2  during  1913 


THE  INCREASE  IN  CANCER 

deaths  from  cancer  would  have  been  90,411  instead  of  44,047.  Is  it  a 
tenable  proposition,  in  view  of  these  facts  of  observed  experience,  that 
the  recorded  increase  in  the  cancer  death  rate  is  only  apparent  and  not 
real?  Is  it  conceivable  that  in  1881  in  these  typical  civilized  countries 
of  the  world  46,364  deaths  from  cancer  were  erroneously  diagnosed  or 
mistakenly  classified  under  some  other  terms?  No  one  familiar  with 
the  attained  status  of  medical  and  surgical  science  in  1881  will  be  likely 
to  maintain  such  a  preposterous  conclusion. 

Another  illustration  is  the  experience  of  the  State  of  Massachusetts. 
In  1871  the  recorded  cancer  death  rate  was  36.9  per  100,000  of  popula- 
tion; by  1881  the  rate  had  increased  to  52.3;  by  1891  to  60.9;  by  1901  to 
73.1,  and  by  1911  to  92.6.  In  1871  the  population  of  the  State  was 
1,494,000  and  the  number  of  deaths  from  cancer  was  551.  If  the  rate 
for  1911,  previously  given  as  92.6,  had  prevailed  in  1871,  there  would 
have  been  1,383  deaths  from  cancer  instead  of  the  551  actually  returned. 
The  State  of  Massachusetts  established  the  registration  of  vital  statistics 
in  1842,  or  five  years  after  the  establishment  of  registration  in  England 
and  Wales.  Boston  has  for  many  years  been  one  of  the  medical  centers 
not  only  of  the  United  States,  but  of  the  world.  There  are  no  reasons 
for  believing  that  medical  diagnosis  was  so  crude  or  imperfectly  devel- 
oped in  1871  that  one  out  of  every  two  deaths  from  cancer  should  have 
been  erroneously  diagnosed  or  wrongfully  classified  under  some  other 
disease.  Nor  is  there  any  evidence  to  substantiate  the  point  of  view 
that  the  age  distribution  of  Massachusetts  has  undergone  such  pro- 
found changes  as  to  account  for  the  higher  frequency  of  cancer  at  the 
present  time.  In  1880  the  proportion  of  population  ages  65  and  over 
in  Massachusetts  was  5.4  per  cent.;  in  1900  it  was  5.1  per  cent.;  in  1910 
it  was  5.2  per  cent.  From  a  practical  point  of  view  in  statistical  anal- 
ysis, these  changes  in  the  age  distribution  can  have  been  of  only  slight 
effect  on  the  cancer  death  rate. 

Cancer  Increase  Throughout  the  World 

Limiting  the  present  observations  to  the  changes  in  the  cancer  death 
rate  during  the  last  decade,  divided  into  two  periods  of  five  years  each,  and 
to  the  principal  countries  of  the  world,  including  the  United  States,  for  all 
of  which  approximately  trustworthy  registration  returns  are  available,  the 
facts,  briefly  summarized,  are  as  follows :  For  all  the  countries  considered, 
with  an  aggregate  population  of  365,083,000  in  1910,  the  cancer  death 
rate  increased  from  67.7  per  100,000  of  population  during  the  first  five 
years  to  74.3  during  the  last.  The  rate  of  increase  was  therefore  equiva- 
lent to  9.7  per  cent.  The  details  of  this  comparison  are  given  in  Table  2, 
iVppendix  G,  on  Cancer  Statistics  of  Foreign  Countries.  The  percent- 
age of  increase  was  28.5  for  Cuba,  23.4  for  Uruguay,  17.6  for  Scotland, 
17.2  for  Ontario,  16.8  for  Brazil,  15.2  for  Italy,  15.0  for  Ireland,  14.8 
for  Japan,  12.5  for  the  Australian  Commonwealth,  12.2  for  Spain,  11.5 
for  Hungary,  11 .5  for  France,  10.2  for  British  Columbia.  Most  of  these 
countries  have  cancer  death  rates  below  the  average  for  all  of  the  coun- 
tries combined.  In  the  countries  with  a  higher  cancer  death  rate,  the 
rate  of  increase,  for  self-evident  reasons,  has  been  less.  A  point  must  be 
reached  beyond  which  no  single  cause  or  group  of  causes  of  death  can 

39 


THE  MORTALITY  FROM  CANCER 

persistently  increase.  In  the  German  Empire  the  cancer  death  rate 
increased  8.5  per  cent.;  in  England  and  Wales,  8.4  per  cent.;  in  Jamaica, 
7.7  per  cent.;  in  New  Zealand,  7.0  per  cent.;  in  the  United  States,  6.9 
per  cent.;  in  Danish  cities,  6.4  per  cent.;  in  Holland,  5.8  per  cent.;  in 
Austria,  4.8  per  cent. ;  in  Sweden,  2.2  per  cent. ;  in  Norway,  1 .8  per  cent. ; 
in  the  Argentine  Republic,  1 .7  percent. ;  in  Switzerland  the  rate  diminished 
1.1  per  cent.  The  rate  for  Switzerland,  however,  during  the  period 
1901-05  was  128.3,  or  nearly  double  the  average  for  all  the  countries 
combined;  during  the  period  1906-10  the  rate  decreased  to  125.9.  Next 
to  Switzerland,  the  cancer  mortality  is  decidedly  excessive  in  the  King- 
dom of  Holland,  where  in  1906-10  it  attained  to  a  rate  of  103.5  per  100,- 
000  of  population.  A  cancer  census  of  Holland  was  published  as  an  ap- 
pendix to  the  cancer  census  of  Germany  in  1902.  In  1911  a  special  report 
was  issued  by  the  Bureau  of  Municipal  Statistics  of  Amsterdam,  on  the 
mortality  from  cancer  during  the  period  1862-1902,  including  some  es- 
pecially interesting  data  on  the  comparative  frequency  of  cancer  among 
Jews  and  Christians.  An  extremely  valuable  portion  of  this  report  is  a 
table  showing  separately  the  deaths  from  cancer  and  sarcoma  during  the 
period  1897-1902,  by  sex  and  single  years  of  life.  In  1911  the  same 
bureau  issued  a  special  volume  of  international  mortality  statistics,  in- 
cluding cancer,  which,  however,  unfortunately  contains  a  number  of 
clerical  errors,  and  in  which  no  distinction  is  made  of  sex,  age,  and  organs 
and  parts.  When  the  cancer  death  rates  are  limited  to  large  cities,  they  are 
naturally  somewhat  higher,  partly  on  account  of  special  opportunities  for 
hospital  treatment.  This  probably  explains  the  relatively  higher  rates 
for  the  cities  of  France  and  Denmark  and  the  Argentine  Republic 
(limited  to  the  Province  and  City  of  Buenos  Aires).  These  conclusions 
regarding  the  increase  in  the  mortality  from  cancer  are  fully  confirmed 
by  the  details  of  the  statistical  analysis  of  the  different  countries  and 
cities  of  the  world,  in  another  portion  of  this  work.* 

The  evidence  is  so  convincing  that  it  may  safely  be  maintained  that 
no  other  statistical  conclusion  in  medicine  is  so  concisely  and  incontro- 
vertibly  established  as  this;  in  any  event,  no  satisfactory  evidence  is 
available  to  successfully  contradict  this  conclusion  at  the  present  time. 
If  all  of  this  evidence,  however,  is  inconclusive  and  worthless,  then  no 
alternative  remains  but  to  discredit  the  statistical  returns  of  every  coun- 
try in  the  world  with  regard  to  any  single  disease  or  group  of  diseases, 
although  the  returns  are  accepted  as  approximately  accurate  with  regard 
to  every  other  important  cause  of  death.  More  than  this,  it  would  seem 
to  follow  as  a  logical  conclusion  that  medicine  has  not  made  the  progress 
that  it  is  generally  assumed  to  have  made  during  the  last  two  generations, 
and  that,  in  fact,  even  now  a  colossal  amount  of  public  ignorance  exists 
regarding  the  most  obvious  evidences  of  malignant  and  destructive  new 
growths.     There  is,  however,  no  substantial  ground  for  such  far-reaching 

*An  important  factor  tending  to  reduce  the  cancer  death  rate  is  the  increasing  practice  of  surgical  operations 
for  malignant  disease.  The  evidence  is  overwhelming  that  a  considerable  number  of  deaths  from  cancer  are 
prevented  by  er.rly  surgical  operations,  and  that  a  large  number  of  deaths  from  malignant  disease  are  in  any 
event  postponed  by  this  means.  Deaths  must  result  to  an  increasing  extent  from  other  causes  than  cancer  in 
the  case  of  cancer  patients  successfully  operated  upon  in  conformity  to  modern  surgical  practice.  Data  are  not 
available  to  determine  the  exact  effect  of  surgery  upon  the  cancer  death  rate,  but  it  is  safe  to  assume  that  but  for 
the  increasing  extent  of  surgical  interference  the  present  cancer  death  rate  would  be  perceptibly  higher  than  is 
actually  the  case. 

40 


THE  INCREASE  IN  CANCER 

conclusions ;  on  the  contrary,  the  evidence  presented  will  stand  the  most 
critical  analysis  in  support  of  the  theory  that  for  practical  purposes  the 
law  of  large  numbers  applies  in  the  present  case  as  in  many  other 
studies  of  collective  phenomena  and  that  the  conclusions  derived  there- 
from may  be  accepted  with  entire  confidence  and  the  reasonable  certainty 
that  they  will  not  be  materially  modified  or  changed  in  important  par- 
ticulars by  subsequent  investigations.* 

Misleading  Statistical  Observations 

It  is  not  practicable  on  this  occasion  to  further  discuss  the  contro- 
versial aspects  of  the  question  whether  cancer  is  on  the  increase  or  not; 
the  burden  of  'proof  rests  with  those  who  maintain  the  negative  point  of 
view.  Qualified  opinion,  generally  speaking,  on  medical  or  surgical 
grounds,  favors  the  conviction  that  cancer  is  actually  and  relatively  on 
the  increase  among  civilized  mankind.  The  evidence  brought  together  by 
R.  W.  Williams  regarding  the  increase  of  cancer  and  its  concomitants  is 
quite  conclusive.  A  considerable  amount  of  additional  evidence  is 
contained  in  the  Proceedings  of  the  German  Society  for  Cancer  Research. 
Reference,  however,  may  properly  be  made  to  an  article  "On  the  Supposed 
Increase  of  Cancer,"  in  the  issue  of  the  Journal  of  the  American  Medical 
Association,  dated  June  24,  1899,  by  E.  Andrews,  M.  D.,  as  an  illus- 
tration of  the  misapplication  of  the  statistical  method  to  research  work 
of  this  kind.  Correct  statistical  analysis  presents  the  same  practical 
difficulties  as  correct  clinical  or  anatomical  diagnosis.  The  article  referred 
to  adds  nothing  of  value  to  cancer  research  and  tends  only  to  confuse  the 
question  at  issue.  In  a  similar  case  in  the  Journal  of  the  American 
Medical  Association  for  November  10,  1906,  Dr.  Robert  Reyburn 
quotes  Dr.  Roswell  Park  to  the  effect  that  "if  the  present  increase  of 
cancer  in  the  United  States  continues  from  1899  to  1909,  there  will  be 
more  deaths  from  cancer  than  from  consumption,  smallpox  and  typhoid 
fever  combined."  This  statement  on  its  face  is  a  self-evident  absurdity. 
In  an  address  delivered  before  a  general  meeting  of  the  Sixteenth 
International  Medical  Congress,  held  in  Budapest,  1909,  and  reprinted 
in  the  New  York  Medical  Record  for  September  4th  of  that  year.  Dr. 
Bashford  commits  himself  to  the  conclusion  that  he  very  much  questions 
"if  those  persons  who  have  made  exaggerated  statements  to  the  effect 
that  the  recorded  increase  in  cancer  represents  a  true  and  relatively 
increased  liability  to  it,  have  any  excuse  whatsoever  for  enhancing  the 
reasonable  anxiety  of  the  lay  public." 

These  observations  are  also  applicable  to  a  very  recent  treatise 
on  "The  Cancer  Problem,"  by  Dr.  William  Seaman  Bainbridge,  which 
includes  a  section  on  "Statistical  Considerations."  It  is  difficult  to  under- 
stand what  practical  value  such  observations  can  serve  in  the  medical 
study  of  the  cancer  problem,  being  simply  a  heterogeneous  collection  of 
mere  figures  derived  from  miscellaneous  sources.  It  is  not  correct,  for 
illustration,  to  say  that  "the  investigations  of  the  Imperial  Cancer 
Research  Fund  have  shown  that  the  disease  occurs  among  all  races  of 
mankind."     The  three  official  reports  published  by  Parliament  regarding 

*There  is  an  extended  statistical  discussion  of  the  cancer  problem  in  the  appendix  of  the  annual  report  of 
the  State  Board  of  Health  of  Massachusetts  for  1900,  but  the  methods  of  statistical  analysis  are  inadequate  to 
the  purpose,  and  the  results  of  the  investigation  are,  therefore,  in  the  main  quite  inconclusive. 

41 


TEE  MORTALITY  FROM  CANCER 

cancer  in  the  British  possessions  throughout  the  world  do  not  include 
all  of  the  world's  races  and  tribes;  nor  were  the  investigations  made 
with  the  required  degree  of  thoroughness  and  completeness.  It  is  also 
not  correct  to 'say  that  in  the  United  States  "there  are  no  reliable  statis- 
tics concerning  either  the  relative  frequency  of  cancer  in  the  past  or  its 
relative  frequency  in  the  different  states,  in  the  different  towns,  or  in 
towns  as  compared  with  country  districts."  This  conclusion  is  merely  a 
repetition  of  the  views  of  the  Director  of  the  Imperial  Cancer  Research 
Fund,  who,  as  shown  by  his  writings,  has  not  the  necessary  knowledge  of. 
American  vital  statistics.  The  present  work  is  an  emphatic  contradiction 
of  the  view  that  American  cancer  mortality  statistics,  past  and  present, 
are  not  in  a  general  way  strictly  comparable  with  the  corresponding  data 
for  other  civilized  countries.  It  is  an  error  to  maintain  that  the  cancer 
death  rate  increases  from  35  to  the  end  of  life.  *  There  are  trustworthy  data 
to  sustain  the  view  that  very  late  in  life  the  cancer  death  rate  is  lower 
than  in  earlier  years.  Finally,  among  other  statistical  errors,  the 
statement  is  made  that  a  comparison  of  the  white  and  the  colored 
cancer  death  rate  is  not  possible,  because,  it  is  claimed,  "the  South  has 
hitherto  been  entirely  unrepresented  by  reliable  state  registration."  The 
required  data  are  not  necessarily  derived  from  the  states  as  a  whole, 
but  for  the  South  from  large  and  representative  cities,  and  for  that  reason 
are  at  least  approximately  trustworthy  with  regard  to  the  negro  element. 

The  Truth  of  the  Cancer  Problem 
Provided  the  arguments  in  favor  of  the  theory  that  cancer  is  on  the 
increase  are  based  upon  trustworthy  official  mortality  statistics,  the 
question  at  issue  is  not  whether  the  anxiety  of  the  public  is  aroused,  but 
whether  the  public  may  rightfully  be  prevented  from  knowing  the  truth. 
From  a  public  point  of  view  it  is  perhaps  immaterial  whether  cancer  is 
actually  or  only  apparently  on  the  increase  or  not,  but  it  is  of  the  utmost 
importance  to  the  people  to  know  whether  cancer  is  in  truth  more 
common  at  the  present  time  than  is  generally  supposed  to  be  the  case. 
If  because  of  erroneous  diagnosis  or  inaccurate  classification  the  cancer 
death  rate  has  been  understated  in  the  past,  it  is  a  public  duty  on  the 
part  of  all  familiar  with  the  facts  to  make  the  truth  known  and  to  establish 
the  menace  of  cancer  beyond  a  doubt.  Only  by  means  of  an  accurate 
perception  of  the  extreme  seriousness  of  the  cancer  question  in  adult  life 
can  the  necessity  for  the  earliest  possible  recognition  and  recourse  to 
qualified  treatment  be  brought  home  to  the  laity,  now  largely  misled  by 
superficial  reasoning  and  hair-splitting  arguments  on  so  important  a 
question  from  a  scientific  point  of  view  as  to  whether  cancer  is  relatively 
more  common  among  civilized  mankind  than  has  generally  been  supposed 

*M0RTALITT   FROM    CanCER   IN   ENGLAND   AND   WaLES,  BY  AqE   AND   Sex,  1901-1910 

Rate  per  100,000  Population 

Ages  Persons  Males  Females 

UnderSS 5.5  4.9  6.1 

36-44 63.7  41.3  84.6 

45-54 194.8  154.8  231.9 

66-64 417.0  390.2  440.8 

66-74 666.2  667.6  665.1 

75-84 795.7  794.1  796.8 

85  and  over 733.7  7Si.9  738.7 

AUAges 90.4  77.3  102.7 

42 


THE  INCREASE  IN  CANCER 

to  be  the  case.  From  a  lay  point  of  view  it  is  not  a  question  whether  the 
observed  increase  in  the  rate  is  real  or  unreal ;  the  question  is  as  to  what 
proportion  of  mortality  is  in  all  probability  caused  by  cancer  in  adult  life 
at  the  present  time ;  and  no  one  familiar  with  the  facts  can  deny  that  the 
public  is  ignorant  or  woefully  misinformed  as  to  the  truth  regarding  the 
seriousness  of  the  cancer  situation  considered  from  this  point  of  view. 

Dr.  James  Ewing  in  an  address  on  "Animal  Experimentation  and 
Cancer"  published  in  the  Journal  of  the  American  Medical  Association 
under  date  of  January  22,  1910,  remarks: 

The  weight  of  evidence  to-day  points  almost  conclusively  to  the  opinion  that  cancer 
is  steadily  increasing  in  frequency  in  man  and  domestic  animals,  and  that  this  increase  is 
likely  to  become  more  pronounced.  Yet,  the  most  diverse  opinions  exist  regarding  the 
alleged  increase  in  cancer,  emanating  from  the  varying  character  of  the  evidence  assumed 
by  different  authorities  as  valid.  Surgeons  are  practically  unanimous  in  the  belief  that 
cancer  has  been  steadily  growing  in  frequency  during  the  last  quarter-century,  and  has 
been  appearing  at  earlier  periods  of  life.  Yet  such  testimony  must  be  regarded  as  some- 
what uncertain  and  unconvincing. 

This  is  a  conservative  statement  by  one  who  properly  takes  rank  as 
one  of  the  foremost  American  pathologists  engaged  in  cancer  research  in 
America  to-day.  It  is  largely  on  this  ground  that  it  has  seemed  advisable 
to  bring  together  the  statistical  facts  regarding  cancer  as  a  world  menace, 
and  the  data  made  available  should  prove  useful  even  to  the  pathologist 
in  the  furtherance  of  specialized  eflPorts  in  cancer  research. 

Useless  Controversies 
In  the  Fourth  Scientific  Report  of  the  Imperial  Cancer  Research  Fund, 
issued  in  1911,  according  to  The  British  Medical  Journal,  of  November 
11th  of  that  year,  Dr.  Bashford  reverts  again  to  the  increase  of  cancer, 
in  the  statement  that,  with  reference  to  British  statistics, 

for  the  first  time,  it  is  fully  demonstrated  that  it  is  erroneous  to  make  statements  of  a  dis- 
quieting nature  about  the  increase  of  cancer  in  general.  While  it  is  evident  that  several 
X)f  the  differences  brought  out  by  the  figures  can  be  explained  by  more  accurate  diagnosis 
and  by  allocation  of  the  seat  of  the  disease  from  the  secondary  to  the  primary  situations, 
as  illustrated,  for  example,  by  the  relation  revealed  between  cancer  of  the  liver  and  gall 
bladder,  and  the  alimentary  tract,  this  may  not  account  fully  for  certain  other  features. 
In  particular,  the  increased  incidence  of  cancer  recorded  for  the  mamma  in  women  and  the 
tongue  in  men,  require  further  study  and  elucidation. 

In  this  statement  it  is  conceded  that  cancer  of  certain  organs  and  parts 
of  the  body  is  obviously  on  the  increase  in  England  and  Wales.  No  one 
qualified  to  discuss  the  statistical  aspects  of  the  cancer  problem  has 
maintained  that  all  forms  of  cancer  are  uniformly  on  the  increase  or  to 
an  equal  degree.  The  rise  in  the  general  death  rate  from  cancer  may  prop- 
erly be  referred  to  as  an  evidence  of  cancer  increase,  without  an  elabora- 
tion of  the  details  regarding  cancer  of  certain  organs  and  parts  of  the 
body.  For  strictly  scientific  and  medical  purposes,  it,  no  doubt,  is  more 
advantageous  to  discuss  the  separate  aspects  of  the  cancer  problem,  just 
as  this  same  conclusion  applies  to  fevers  or  tubercular  diseases.  No 
subject  can  reach  scientific  perfection  except  by  gradual  evolution  from 
broad  generalizations  to  particular  points  of  controversy.  It  is  therefore 
entirely  correct  to  speak  of  an  increase  in  the  mortality  from  cancer,  even 
though  not  all  forms  of  cancer  may  be  increasing  or  increasing  at  the 
same  rate;  in  fact,  there  is  sufficient  evidence  to  prove  that  certain  forms 

43 


THE  MORTALITY  FROM  CANCER 

of  cancer  in  certain  parts  of  the  world  or  particular  localities  are  practi- 
cally stationary  or  are  actually  diminishing.  This  is  a  problem  of  special 
analysis  of  cancer  data,  which,  no  doubt,  is  urgently  needed,  but  which 
has  not  been  forthcoming  through  the  efforts  of  the  Imperial  Cancer 
Research  Fund.  The  subject  is  again  briefly  referred  to  in  the  Twelfth 
Annual  Report  of  the  Imperial  Cancer  Research  Fund,  in  which  the 
curious  opinion  is  expressed  that  "the  more  general  attention  to  the  age 
factor  in  official  statistics  in  connection  with  cancer  inquiries  has  rendered 
a  further  statistical  report  superfluous." 

Trustworthiness  of  American  Mortality  Statistics 
On  account  of  the  pronounced  position  to  which  Dr.  Bashford  has  com- 
mitted himself  in  this  matter,  it  is  necessary  to  refer  to  an  address 
delivered  in  the  city  of  New  York,  at  the  Academy  of  Medicine,  in  1912. 
In  this  address,  as  reported  in  the  New  York  Sun,  under  the  title  "Doubts 
that  Cancer  is  on  the  Increase,"  occurs  the  statement  that  Dr.  Bashford 
was  unable  to  obtain  American  cancer  mortality  statistics  with  particular 
reference  to  age  and  sex  and  organs  and  parts  of  the  body,  because  such 
data  were  non-existent  for  the  United  States  or  any  of  its  component 
parts.  He  therefore  was  reported  to  have  said  that  "I  cannot  compre- 
hend why  you  citizens  of  a  great  state  like  New  York  permit  this. 
Doubtless  the  data  exist,  but  as  far  as  I  know  they  have  never  been 
published,  and  therefore  the  statistics  that  mean  so  much  in  the  study 
of  cancer  here  are  not  to  be  obtained."  This  statement  is  in  flat  con- 
tradiction to  the  facts.  Since  1900  at  least,  complete  cancer  statistics 
for  the  registration  area  of  the  United  States  and  its  component  parts 
have  been  published  annually  by  the  Division  of  Vital  Statistics  of  the 
United  States  Census,  with  a  due  regard  to  age  and  sex  and  organs  and 
parts,  and  they  have  been  available  for  some  of  the  states  and  for 
many  of  our  American  cities  for  a  much  longer  period  of  years.  It  is 
the  particular  purpose  of  the  present  study  to  present  these  facts  to  the 
public  in  a  convenient  form  for  the  required  thorough  and  extended 
consideration  of  what  may  be  properly  considered  one  of  the  foremost 
medical  problems  of  the  present  day. 

Contributory  Causes  of  Death  in  Cancer 

It  has  not  been  feasible  to  give  even  preliminary  consideration  to  the 
extremely  important  question  of  causes  of  death  in  cancer  patients  as 
disclosed  by  autopsy  records.  Obviously  concurrent  diseases  must 
be  relatively  common  in  cancer  patients,  considering  the  depressed 
vitality  and  diminished  disease  resistance,  at  least  during  the  last  few 
months  of  the  cancer  patient's  life.  The  only  extended  study  of  this  phase 
of  the  cancer  problem  appears  to  have  been  made  by  Dr.  M.  Simmonds,  of 
the  General  Hospital  of  Hamburg,  "An  welchen  Komplikationen  sterben 
Krebskranke?"  Zeitschrift  fiir  Krebsforschung,  Vol.  I,  1903-04,  p.  315. 
This  author,  on  the  basis  of  760  autopsies,  brings  out  the  important  fact 
that  a  considerable  variation  is  met  with  in  the  contributory  causes  of 
death,  according  to  the  primary  seat  of  the  disease.  In  brief,  the  investiga- 
tion by  Simmonds  shows  as  follows :  In  cancer  of  the  lungs,  or  respiratory 
diseases,  out  of  18  cases,  10  were  complicated  bypneumonia,  4  by  cachexia, 
and  4  by  other  diseases ;  in  cancer  of  the  buccal  cavity  and  oesophagus,  out 


THE  INCREASE  IN  CANCER 

of  117  cases,  47  were  complicated  by  pneumonia,  24  by  cachexia,  15 
by  lung  abscess  and  gangrene,  9  by  pleuritis,  6  by  pericarditis,  5  by 
tuberculosis,  and  1 1  by  other  diseases ;  in  cancer  of  the  stomach,  out  of 
272  cases,  129  were  complicated  by  cachexia,  69  by  pneumonia,  19  by 
peritonitis,  10  by  jaundice,  6  by  pleuritis,  5  by  embolism,  5  by  tuber- 
culosis, and  29  by  other  diseases;  in  cancer  of  the  intestines,  out  of  62 
cases,  12  were  complicated  by  cachexia,  11  by  pneumonia,  10  by  pyelone- 
phritis and  cystitis,  10  by  peritonitis,  6  by  ileus,  and  13  by  other  diseases; 
in  cancer  of  the  peritoneum,  pancreas,  liver  and  gall-bladder,  out  of 

47  cases,  18  were  complicated  by  jaundice,  16  by  cachexia,  8  by  pneu- 
monia, and  5  by  other  diseases;  in  cancer  of  the  kidneys,  bladder  and 
prostate,  out  of  23  cases,  13  were  complicated  by  cystitis,  pyelone- 
phritis and  hydronephrosis,  5  by  cachexia,  and  5  by  other  diseases;  in 
cancer  of  the  female  generative  organs,  out  of  168  cases,  87  were  com- 
plicated by  cystitis,  pyelonephritis  and  hydronephrosis,  28  by  ca- 
chexia, 21  by  pneumonia,  16  by  peritonitis,  and  16  by  other  diseases; 
in  cancer  of  the  female  breast,  out  of  46  cases,  30  were  complicated 
by  cachexia,  9  by  pneumonia,  and  7  by  other  diseases;  out  of  7  cases 
of  cancer  of  the  skin,  3  were  complicated  by  pneumonia,  and  4  by  other 
diseases.  This  analysis  is  extremely  interesting  from  the  practical 
point  of  view  of  general  diagnosis.  The  investigation  shows  conclu- 
sively that  a  wide  degree  of  variation  in  contributory  diseases  is  met  with, 
according  to  the  organ  or  part  of  the  body  affected  with  malignant 
disease.  For  cachexia,  which  includes  general  carcinosis,  the  proportion 
of  complications  was  22  per  cent,  in  cancer  of  the  lungs  and  respiratory 
organs,  20  per  cent,  in  cancer  of  the  buccal  cavity  and  oesophagus, 

48  per  cent,  in  cancer  of  the  stomach,  20  per  cent,  in  cancer  of  the 
intestines,  34  per  cent,  in  cancer  of  the  peritoneum,  pancreas,  liver  and 
gall-bladder,  22  per  cent,  in  cancer  of  the  kidneys,  bladder  and  prostate, 
17  per  cent,  in  cancer  of  the  female  generative  organs,  and  67  per  cent, 
in  cancer  of  the  female  breast.  Inflammation  of  the  lungs,  including 
pneumonia,  was  a  complicating  factor  in  66  per  cent,  of  cases  of  cancer 
of  the  respiratory  organs,  in  60  per  cent,  of  cancer  of  the  buccal  cavity 
and  oesophagus,  in  25  per  cent,  of  cancer  of  the  stomach,  in  20  per  cent, 
of  cancer  of  the  intestines,  in  17  per  cent,  of  cancer  of  the  peritoneum, 
pancreas,  liver  and  gall-bladder,  in  17  per  cent,  of  cancer  of  the  kidneys, 
bladder  and  prostate,  in  15  per  cent,  of  cancer  of  the  female  generative 
organs,  and  in  24  per  cent,  of  cancer  of  the  female  breast. 

The  relation  of  the  contributory  or  secondary  cause  of  death  to  the 
seat  of  primary  growth  is  therefore  of  considerable  practical  importance.* 
The  investigation  by  Simmonds  shows  that  in  33  per  cent,  of  the  cases 
there  were  no  serious  complications  whatever;  and  in  33  per  cent.,  also, 
there  were  direct  contributory  causes   of  serious  significance,   chiefly 

*Secondary  causes  of  death  in  cancer  are  comparatively  rarely  mentioned  in  death  certificates.  Out  of 
2,531  male  deaths  from  cancer  in  the  Industrial  experience  of  The  Prudential,  1909-10,  only  108,  or  4.3  per 
cent.,  of  the  certificates  of  death  gave  secondary  or  supplementary  causes,  including  6  from  pulmonary 
tuberculosis,  1  from  diabetes  (none  from  alcoholism),  23  from  heart  and  other  circulatory  diseases,  8  from 
pneumonia  and  pulmonary  congestion,  1  from  appendicitis,  2  from  biliary  calculi,  24  from  acute  and  chronic 
nephritis  and  10  from  dropsy.  Out  of  5,304  deaths  from  cancer  among  females,  the  certificate  of  death 
gave  additional  information  in  225  cases,  or  4.2  per  cent.,  including  13  from  pulmonary  tuberculosis,  5  from 
diabetes,  1  from  alcoholism,  30  from  heart  and  circulatory  diseases,  20  from  pneumonia  and  pulmonary  con- 
gestion (none  from  appendicitis),  17  from  biliary  calculi,  43  from  acute  and  chronic  nephritis,  3  from 
parturition  and  11  from  dropsy. 

45 


TEE  MORTALITY  FROM  CANCER 

pyelonephritis  and  cystitis,  peritonitis,  jaundice;  in  30  per  cent,  there 
were  remote  contributory  causes,  not  directly  related  to  the  cancerous 
processes,  chiefly  pneumonia  and  pleuritis;  and  in  4  per  cent,  there  were 
very  remote  contributory  conditions,  chiefly  tuberculosis,  embolism 
of  the  brain,  and  arteriosclerosis,  in  no  direct  relation  whatsoever  to 
the  death  from  malignant  disease.  In  other  words,  summarizing  the 
results  of  this  investigation,  in  one-third  of  the  cases  there  were  no 
serious  contributory  causes  of  death,  and  in  two-thirds  there  were  such 
secondary  complications,  of  which  about  one-half  were  of  diagnostic 
significance.* 

Continued  Increase  in  Cancer  Frequency 

In  concluding  these  observations  on  the  general  aspects  of  the  question 
whether  cancer  is  on  the  increase  or  not,  a  brief  reference  requires  to  be 
made  to  the  discussion  of  the  subject  before  the  Cancer  Research  In- 
stitute, held  at  the  New  York  Academy  of  Medicine,  May  15,  1913. 
On  this  occasion.  Prof.  W.  F.  Willcox,  of  Ithaca,  N.  Y.,  in  summarizing 
the  arguments  of  Messrs.  King  and  Xewsholme,  presented  to  the  Royal 
Society  in  1893,  and  in  supporting  their  conclusions,  said:  "After  an 
analysis  of  this  and  other  evidence  it  may  be  concluded  that  probably 
the  larger  part  and  possibly  all  of  the  increase  in  the  mortality  from 
cancer  is  apparent  rather  than  real,"  and  that  "Those  who  doubt  this 
conclusion  and  hold  that  most  of  the  increase  is  real  may  interpret  the 
evidence  as  sho-odng  that  the  real  increase  is  not  at  a  geometrical  or 
even  an  arithmetical  rate,  but  diminishes  as  the  death-rate  from 
cancer  rises  and  that,  perhaps,  in  certain  limited  areas,  like  Switzerland 
and  a  few  cities,  it  is  already  approaching  its  maximum."  Prof.  Willcox 
did  not  present  any  new  data  or  an  original  analysis  of  the  available 
statistical  material,  but,  as  pointed  out,  he  merely  summarized  his  own 
views,  based  upon  those  of  Messrs.  King  and  Newsholme  and  the  con- 
veniently available  statistics,  chiefly  those  published  by  the  city  of 
Amsterdam  in  1911-12,  and  the  annual  reports  for  the  registration  area 
of  the  United  States.  A  death  rate  from  any  special  cause  could  not 
possibly  continue  to  increase  indefinitely  and  at  a  'progressive  rate.  It  is 
self-evident  that  a  death  rate  from  any  cause  when  once  it  reaches  con- 
siderable proportions  must  naturally  diminish  in  its  rate  of  increase, 
because  of  inherent  limitations.  This  applies  to  population  growth  as  well 
as  to  mortality.  The  argument  is  the  same  as  is  frequently  advanced  in 
the  case  of  tuberculosis,  where  it  is  claimed  by  the  superficially  informed 
and  by  those  untrained  in  statistical  analysis  that,  because  the  decline  in 
the  tuberculosis  death  rate  in  recent  years  has  been  at  a  lower  rate  than 
in  former  years,  the  deliberate  effort  to  bring  about  a  reduction  in  mor- 
tality has  been  largely  a  failure. f 

Combining  the  principal  European  countries  for  the  period  1896-1900, 
the  average  cancer  death  rate  during  that  period  was  69.1  per  100,000 
of  population.     It  was  as  high  as  127.4  in  Switzerland  and  as  low  as 

*The  most  thorough  consideration  of  this  aspect  of  the  problem  is  contained  in  the  76th  Annual  Report  of 
the  Registrar-General  of  Births,  Deaths  and  Marriages  in  England  and  Wales,  London,  1915. 

tFor  a  discussion  of  the  statistical  aspects  of  the  tuberculosis  problem,  with  special  reference  to  the  decline 
in  the  death  rate,  see  my  address  before  the  National  Association  for  the  Study  and  Prevention  of  Tubercu- 
losis, Washington,  May  8, 1913. 

46 


THE  INCREASE  IN  CANCER 

30.7  in  Hungary.  During  the  five-year  period  ending  with  1905,  the 
rate  increased  to  74.2.  The  actual  increase  in  the  rate  was  therefore 
5.05  per  100,000  of  population.  The  rate  for  Switzerland  during  this 
period  was  as  high  as  128.3,  and  for  Hungary  as  low  as  39.1.  During 
the  five  years  ending  with  1910  the  average  cancer  death  rate  for 
European  countries  was  81.0.  There  was  therefore  an  actual  increase 
in  the  rate  of  6.81  per  100,000  of  population,  against  5.05  for  the 
previous  quinquennial  period,  and  the  percentage  of  increase  in  the 
rate  was  9.2,  against  7.3  for  the  previous  five  years.  The  theory 
advanced  by  Prof.  Willcox  is  therefore  not  sustained  by  the  facts  of 
actual  experience,  which,  to  the  contrary,  prove  beyond  a  doubt  that  the 
actual  as  well  as  the  relative  increase  in  the  cancer  death  rate  in  at  least 
some  of  the  more  important  countries  continues  progressively  at  the 
present  time  and  that  for  most  of  the  civilized  countries  a  maximum 
rate  is  far  from  having  been  reached. 

The  Menace  of  Public  Ignorance  and  Indiflference 

The  cancer  problem  is  one  of  the  most  difficult  and  perplexing  in  medi- 
cine, surgery  and  statistics.  The  mortality  from  cancer  is  no  longer  to 
be  considered  indifferently,  for  it  constitutes  a  real  menace  to  all  civilized 
mankind.  Irrespective  of  the  reasons  w  hy  the  aggregate  mortality  from 
this  disease  should  be  so  large,  amounting,  now  (1915),  in  the  Continental 
United  States  to  over  80,000  per  annum,  it  is  a  self-evident  duty  on  the 
part  of  all  familiar  with  the  facts  to  discuss  the  subject,  with  a  due  re- 
straint in  their  utterance,  but  with  clearness  and  fearlessness,  so  that  the 
public  may  be  made  aware  of  the  dreadful  truth.  It  is  entirely  irrelevant 
and  a  wrongful  use  of  the  critical  method  to  charge  those  who  are  con- 
vinced that  cancer  is  becoming  an  increasing  menace  to  civilized  peoples 
with  an  exaggeration  of  the  situation  or  with  an  undue  excitement  of  the 
public.  No  harm  is  ever  likely  to  come  to  any  person  by  being  unduly 
alarmed  on  this  account.*  The  harm  and  the  dreadful  seriousness  lie  in 
ignorance  and  indifference  and  in  confusion  worse  confounded  by  need- 
less controversies  over  matters  which  in  themselves  are  at  most  and  at 
best  but  secondary  to  the  supreme  question  as  to  how  malignant  dis- 
ease can  be  controlled ;  how  it  can  be  prevented,  on  the  one  hand,  and 
how  it  can  be  successfully  cured,  on  the  other. f 

*The  psychological  aspects  of  the  cancer  agitation  have  been  discussed  by  Dr.  Romer,  of  Stuttgart,  in 
the  Journal  of  the  German  Society  for  Cancer  Research,  Berlin,  1906,  Vol.  iv. 

fFor  a  general  statement  of  these  aspects  of  the  cancer  problem,  gee  my  address  on  "The  Menace  of  Can- 
cer," transactions  of  the  American  Gyijecologjcal  Soyety,  1913, 


47 


CHAPTER  IV 
MORTALITY  FROM  CANCER  IN  DIFFERENT  OCCUPATIONS 

Review  of  the  Literature  on  Cancer  in  Relation  to  Occupation — Cancer  in  the  Patent-fuel 
Industry — Pitch  Ulceration  and  Paraffin  Cancer — Occupational  Incidence — Alco- 
holism— Prisons  and  Asylums — Petroleum  Industry — Malignant  Disease  of  the  Lungs 
in  Miners — Gardening  and  Agriculture — Cancer  among  Paraffin-workers — Brewers — 
Furriers  and  Skinners — Seamen — Tinplate-workers — Lead-workers — Rubber- workers 
— Chemical-workers — X-ray  Workers — Cancer  and  Exposure  to  Light — Cancer  in 
the  Synthetic-dye  Industry — Occupational  Mortality  Statistics — Life  Insurance 
Experience — Foreign  Statistical  Investigations — Requirements  of  Scientific  Statistical 
Research. 

A  full  discussion  of  the  occupational  aspects  of  the  cancer  problem  is 
at  present  out  of  the  question,  on  account  of  the  paucity  of  data  and  the 
doubtful  value  of  a  considerable  amount  of  available  statistical  informa- 
tion. Most  of  the  cancer  statistics  by  occupation  fail  to  differentiate  the 
organs  and  parts  of  the  body  affected,  so  that  the  initial  seat  of  the  disease 
can  not  be  correlated  to  the  known  factors  or  conditions  producing  irrita- 
bility, or  traumatism,  and  the  resulting  malignant  growth.  Authori- 
ties on  the  subject  of  workmen's  compensation  for  industrial  diseases 
are  very  guarded  in  their  references  to  the  interrelation  of  accidental 
injuries  to  cancerous  growth,  excepting  such  forms  of  malignant  disease 
as  will  subsequently  be  discussed,  with  the  required  brevity,  but  in 
sufficient  detail  to  emphasize  the  points  of  most  practical  importance. 
From  a  statistical  point  of  view,  however,  the  occupational  aspects  of 
the  cancer  problem  are  of  exceptional  interest  and  deserving  of  much 
more  technical  consideration  than  has  been  given  to  this  phase  of  the 
subject  in  the  past.  The  evidence  is  apparently  conclusive  that 
specific  injuries  to  different  parts  of  the  body,  whether  internal  or 
external,  especially  injuries  resulting  in  a  long-continued  condition  of 
slight  irritability,  may  develop  into  cancerous  growths  of  every  known 
variety  and  degree  of  malignancy.* 

The  frequency  of  cancer  naturally  varies  widely  in  different  occu- 
pations and  industries.  The  results  of  statistical  investigations  regard- 
ing cancer  frequency  in  different  employments  are,  however,  often  con- 
tradictory and,  on  the  whole,  rather  inconclusive.  Cancer  as  a  cause  of 
invalidity  is,  according  to  German  experience,  not  of  serious  importance. 
Out  of  every  1,000  recipients  of  invalidity  annuities,  the  proportion 
retired  on  account  of  cancer  was  16  for  males  and  21  for  females.  The 
corresponding  proportions  for  tuberculosis  of  the  lungs  were  122  for 

*The  earliest  reference  to  tumors  in  relation  to  occupation  occurs  in  "A  Treatise  on  the  Diseases  of  Trades- 
men," by  Ramazzini,  of  which  an  English  translation  was  published  in  London,  1705.  The  references  are  practi- 
cally limited  to  ulcers,  the  term  tumor  being  used  only  once  in  connection  with  the  diseases  of  musicians  and 
others  of  this  profession.  Ramazzini  was  an  exceptionally  careful  observer,  and  it  is  a  reasonably  safe  inference  that 
if  malignantdiseasehadbeenascommonasitis  to-day,  he  would  have  given  a  descriptive  account  of  it  in  his  work. 

Thackrah  iu  his  treatise  on  the  effect  of  arts,  trades  and  professions  on  health  and  longevity,  published 
London,  18:i'2,  makes,amongothers,thefollowingreferences  to  cancer  in  relation  to  occupation.  He  mentions  a 
French  authority  to  the  effect  that  shoemakers  are  subject  to  cancer  of  the  stomach;  that  bakers  are  subject 
to  tumors;  that  grocers  are  liable  to  a  cutaneous  eruption,  or  a  variety  of  eczema,  produced  by  handling  sugar, 
and  that  victims  of  mental  depression  and  care  aje  peculiarly  liable  to  scirrhus  of  the  stomach,  medullary  and 
fungoid  tumors  and  other  malignant  disease. 

48 


CANCER  AND  OCCUPATION 

males  and  76  for  females.  The  relative  importance  of  cancer  as  a 
cause  of  invalidity  is  brought  out  by  the  fact  that  in  German  experience 
it  was  the  seventeenth  most  important  cause  among  males,  and  the 
fifteenth  among  females.  Sir  Thomas  Ohver,  in  his  treatise  on  "Dis- 
eases of  Occupation,"  has  observed  that 

The  relation  of  malignant  disease  and  injury  is  frequently  raised  in  medico-legal  in- 
quiries. That  cancerous  and  sarcomatous  tumors  develop  after  an  accident,  close  to  the 
site  of  the  injury,  and  that  the  one  is  the  direct  sequence  of  the  other,  there  is  not  the  least 
doubt.  How  the  tumor  comes  we  do  not  always  know.  A  man  receives  an  injury  to  the 
right  side  of  his  chest  and  dies  ten  months  afterwards  from  malignant  disease  of  the  liver; 
another  man  falls  on  his  head  in  a  shipyard,  and  a  year  or  two  afterwards  dies  from  a 
sarcomatous  growth  in  the  brain.  In  some  cases  the  connection  is  clear  enough  and  the 
claim  for  compensation  can  be  honestly  maintained,  but  it  is  absolutely  necessary,  in  all 
such  cases  leading  to  a  fatal  termination,  that  a  post-mortem  examination  should  be  made 
in  order  to  ascertain  whether  what  is  apparent  on  the  surface  of  the  body  is  the  primary 
or  secondary  growth. 

Chimney-sweeps'  Cancer 

Concerning  chimney-sweeps'  cancer  the  same  authority  remarks  that 

Men  following  this  employment  exhibit  a  liability  to  cancer  several  times  greater  than 
that  of  the  general  population.  There  is  the  opinion  that  the  irritant  in  soot  is  arsenic,  but 
whether  it  is  this  or  sulphurous  acid  or  ammonia  compounds  it  is  difficult  to  say.  In  New- 
castle-upon-Tyne we  seldom  see  cases  of  chimney-sweeps'  cancer,  although  it  was  the 
cause  of  death  of  one  sweep  in  1907.  In  the  I-ondon  hospitals  and  on  the  Continent  it  is 
not  met  with  so  frequently  as  formerly.  According  to  statistics  suppUed  by  Dr.  John 
Tatham,  of  the  General  Register  Office,  the  comparative  mortaUty  figure  for  cancer  among 
chimney-sweeps  between  the  ages  of  25  and  65  for  the  three  years  ending  1902  was  133  as 
compared  with  63  among  occupied  males  at  the  same  ages.  This  is  a  lower  death  rate 
from  cancer  in  chimney-sweeps  than  three  decades  ago,  and  even  later.  In  his  article  on 
dust-producing  occupations  in  "Dangerous  Trades,"  Dr.  Tatham  gives  as  the  mortahty 
figures  from  cancer  156  for  chimney-sweeps  compared  with  44  for  occupied  males.  While, 
therefore,  the  mortality  from  cancer  has  been  diminishing  in  chimney-sweeps,  it  has  been 
rising  in  the  general  population.  Although  usually  met  with  in  the  region  of  the  scrotum, 
the  disease  may  appear  on  any  part  of  a  chimney-sweep's  body.  It  is  usually  preceded  by 
one  or  two  small  warty  growths  which  ulcerate,  and  these,  failing  to  heal,  assume  the 
character  of  an  epithehoma.  The  glands  in  the  groin  subsequently  become  enlarged,  first 
from  irritation  and  secondly  from  mahgnant  infection.  The  disease  makes  slow  but 
steady  progress.  Ultimately  secondary  deposits  occur  in  such  of  the  internal  organs  as 
the  liver  and  lungs  and  in  the  peritoneal  cavity. 

Gardeners'  Cancer 
With  reference  to  gardeners'  cancer  Sir  Thomas  Oliver  points  out: 

Gardeners  who  are  in  the  habit  of  sprinkhng  soot  upon  plants  to  protect  them  from 
slugs  occasionally  develop  cancerous  ulceration  of  the  hand.  Soot  when  repeatedly 
applied  to  the  skin  causes  it  to  become  thickened,  harsh,  and  dry.  Once  structural  altera- 
tions are  induced  in  the  skin,  repeated  irritation  may  lead  to  cancer. 

Coal-tar  and  Pitch  Industries 

The  same  authority  refers  briefly  to  workers  in  coal-tar  and  pitch,  etc., 
as  follows : 

Men  who  work  in  tar  and  paraffin  and  in  anthracene,  a  product  obtained  from  the 
distillation  of  gas-coal  tar,  are  specially  prone  to  suffer  from  warts  and  skin  eruptions. 
Distillers  of  benzine  and  creosote  suffer  in  a  similar  manner,  although  not  so  frequently. 
Ulcers  of  the  skin  in  persons  who  are  working  among  coal-tar  and  pitch  products  ought 
not  to  be  neglected.  In  the  first  instance  the  ulcer  may  be  of  a  simple  character  and  will 
heal  if  properly  treated  and  kept  free  from  irritation.  Should  it  cease  to  heal,  extirpation 
by  the  surgeon  may  be  required. 


THE  MORTALITY  FROM  CANCER 

The  liability  of  tar  and  pitch  workers  to  cancerous  affections  is  more 
fully  discussed  by  Sir.  Thomas  OUver  in  the  extract  given  below; 

Many  of  the  men  who  follow  the  employment  not  only  become  bronzed  and  sallow,  but 
their  skin  becomes  the  seat  of  a  pecuhar  cancroid  eruption  such  as  is  occasionally  met  with 
on  the  scrotum  of  chimney-sweeps.  In  other  persons  there  may  be  bronchitis,  digestive 
disorders  with  dark  stools,  also  ulceration  of  the  nose.  The  question  as  to  whether 
manipulation  of  tar  products  or  exposure  to  the  fumes  given  off  by  coal-oil  and  tar  is 
capable  of  giving  rise  to  cancer  has  come  before  me  in  the  case  of  three  men  employed  in 
grease  works.  These  men  in  follo-ning  their  employment  all  worked  with  their  sleeves 
rolled  up  to  above  the  elbow.  It  has  been  observed  in  the  trade  that  when  men  have  M'arts 
on  their  hands  these  frequently  disappear  when  they  first  undertake  the  work,  and,  on  the 
other  hand,  that  in  men  whose  skin  has  been  quite  healthy,  wart-like  growths  are  apt  to 
develop  when  they  have  followed  their  employment  for  some  time.  In  addition  to  the 
warts,  of  which  there  may  be  as  many  as  from  thirty  to  forty  on  the  hands  and  forearms, 
there  develop  hard  nodules  in  the  skin  which  ulcerate  and  often  exhibit  very  little  tendency 
to  heal.  The  edges  become  hard,  and  the  ulceration,  extending  to  the  deeper  tissues,  may 
ultimately  involve  t'  e  bone  and  necessitate,  as  in  the  case  of  one  of  the  men  I  have  alluded 
to,  amputation  of  the  arm.  The  appearances  presented  by  the  ulcer  are  those  of  the  type 
of  cancer  known  as  epithelioma.  The  presence  of  these  warty  growths  on  the  forearms 
and  hands,  and  of  ulcers  that  tend  to  take  on  malignant  characters,  in  tar  and  pitch 
workers  is  so  frequent  that  they  must  be  in  some  way  or  other  associated  with  the  employ- 
ment. The  morbid  processes  advance  very  slowly,  and  therefore  do  not  readily  unfit  the 
individual  for  work.  In  many  instances  removal  of  the  ulcer  is  not  followed  by  any 
recurrence  of  the  growth,  but  a  return  to  the  work  lays  the  person  open  to  fresh  develop- 
ments. On  the  forearms  of  one  of  the  grease  workers  above  mentioned  there  are  numerous 
small  patches  of  induration,  some  of  which  have  ulcerated  and  exhibit  no  tendency  to  heal. 
The  edges  of  the  ulcers  are  hard  and  brawny.  There  are,  in  addition,  scattered  all  over  the 
forearm  numerous  black  warts  of  various  sizes,  also  several  scars  of  a  pale  color  compared 
with  the  bronzed  skin  that  surrounds  them.  One  of  these  men,  aged  fifty-eight,  has 
worked  among  coal-oil  and  tar  products  for  thirty  years.  The  scars  referred  to  are  the 
remains  of  ulcers  that  have  healed.  In  the  case  of  his  son,  aged  twenty-seven  years,  the 
ulceration  took  on  the  characters  of  malignant  disease,  and  on  that  account  the  arm  had 
to  be  amputated  above  the  elbow.  Although  it  is  usual  when  the  disease  is  treated  by 
surgical  operation  for  no  recurrence  of  the  growth  to  take  place,  in  this  particular  instance 
the  glands  in  the  armpit  and  neck  became  subsequently  enlarged  owing  to  infective  parti- 
cles having  reached  these  glands  by  the  lymphatics,  and  the  patient  became  the  subject  of 
secondary  cancer.  Microscopical  examination  of  the  ulcer  leaves  no  doubt  as  to  the 
cancerous  nature  of  the  lesion. 

Cancer  as  an  Occupational  Disease 

The  predisposition  to  cancerous  affections  in  certain  occupations  is 
attracting  attention  on  account  of  the  pecuniary  aspects  of  the  modern 
doctrine  of  workmen's  compensation.  In  a  treatise  on  "The  Law  of 
Compensation  for  Industrial  Diseases,"  by  Edward  Thornton  Hill 
Lawes  (London,  1909),  the  subject  is  referred  to  in  part,  as  follows: 

Epitheliomatous  Cancer  or  Ulceration  of  the  Skin,  or  of  the  Corneal  Surface  of  the  Eye, 
due  to  Pitch,  Tar,  or  Tarry  Compounds. 

Description  of  Process. — HandHng  or  use  of  pitch,  tar,  or  tarry  compounds. 

EpitheUoma  is  a  cancerous  growth  of  the  cells  of  the  skin.  It  is  the  least  malignant 
form  of  cancer,  and  on  removal  it  is  not  usually  followed  by  recurrence. 

Tar  has  a  pecuhar  and  irritating  action  upon  the  skin  which  varies  in  intensity.  Those 
who  handle  and  use  pitch  or  tarry  products,  men  employed  in  unloading,  in  making  bri- 
quettes (which  are  a  mixtiu-e  of  pitch  and  coal  dust),  in  handling  "coal  oil"  or  creosote,  are 
all  liable  to  suffer  from  warty  growths,  which  ulcerate  and  may  become  the  seat  of  epithe- 
liomatous  cancer.  The  growths  occur  on  any  part  of  the  body,  especially  the  faice,  hands, 
and  scrotum,  and  are  often  accompanied  with  a  dark  pigmentation  of  the  skin.  They 
commence  as  small  nodules,  but  soon  break  down,  forming  an  ulcer  covered  by  a  crust, 
which  gives  the  appearance  of  the  so-called  wart.  The  underlying  ulcer  almost  invariably 
heals  up,  leaving  a  small  scar  when  the  crust  has  fallen  off.  If  the  growth  becomes  epitheli- 
omatous  the  situation  is  almost  invariably  on  the  scrotum,  when  it  involves  the  neighboring 

50 


CANCER  AND  OCCUPATION 

organs  and  tissues.  It  ia  then  much  the  same  as  chimney-sweeps'  cancer,  and  may 
be  serious,  as  it  can  only  be  arrested  by  free  excision,  and  the  patient  may  lose  one  or  both 
testicles.  Cleanliness  is  a  very  necessary  precaution,  but  in  spite  of  this,  the  disease  may 
develop.  The  length  of  the  incapacity  is  not  great  in  most  cases,  and  the  worker  may 
completely  recover  and  resume  his  work.  Particles  of  pitch  striking  the  eye  may  cause 
inflammation  of  the  conjunctiva  (the  mucous  membrane  covering  the  eye-ball)  and  the 
cornea.  This  may  be  very  serious;  cases  of  this  kind  are  said  to  do  very  badly.  It  is  said 
that  the  pitch  getting  into  the  surface  of  the  eye  causes  a  wound  which  lets  in  bacteria 
which  induce  a  septic  inflammation,  and  there  is  danger  of  loss  of  sight. 

Scrotal  Epithelioma  (Chimney-sweeps'  Cancer). 

Description  of  Process. — Chimney  sweeping. 

Soot  sets  up  an  irritation  of  the  skin  similar  to  pitch  and  tar,  and  with  similar  results 
as  described  under  the  last  heading. 

This  cancer  of  the  scrotal  region  is  so  prevalent  amongst  chimney-sweeps  that  it  owes 
its  name  to  this  fact,  and  though  it  is  occasionally  found  in  other  people,  it  is  distinguished 
from  other  forms  of  cancer,  and  is  characteristic  of  the  trade,  and  is  therefore  scheduled 
separately.  Amongst  chimney-sweeps  it  has  been  the  cause  of  excessive  mortality. 
According  to  the  Registrar's  figures  for  three  years  the  comparative  mortality  from  this 
disease  was  133  per  1,000,  as  against  63  amongst  other*  occupied  males  of  the  same  ages 
[i.  e.,  25-64]. 

This  form  of  cancer  is  invariably  cutaneous  and  of  slow  growth :  it  is  frequently  pre- 
ceded by  a  warty  ulcerous  growth,  which  may  exist  for  some  time  before  becoming  cancer- 
ous, but  the  warts  described  as  common  among  pitch  workers  are  not  so  frequent  in 
chimney-sweeps.  There  is  probably  some  unknown  property  in  soot  which  makes  it 
cancerous:  not  merely  its  grittiness.  See,  however.  Dr.  Butlin's  opinion  contra,  p.  56  of 
the  Minutes  of  the  Industrial  Diseases  Committee,  1907.  Cleanliness  is  an  important 
precaution. 

Cancer  in  the  Patent-fuel  Industry 

The  following  are  interesting  references  to  cancerous  affections  in 
certain  occupations,  from  the  annual  report  of  the  Chief  Inspector  of 
Factories  and  Workshops  for  1908: 

The  reportable  cases  of  epitheHoma  are  likely  to  increase  in  nimaber  as  this  addition 
to  the  schedule  of  diseases  of  occupation  becomes  better  known  throughout  the  large 
patent  fuel  works  in  certain  parts  of  the  divnsion.  Mr.  Hilditch  (Swansea)  reiterates  his 
opinion  that  anthracene  is  the  root  cause  of  this  trouble.  In  support  of  that  view  he  cites 
the  case  of  a  man,  recently  seen  by  him,  who  was  covered  with  warts  on  the  exposed  sur- 
face of  his  body,  and  who  had  been  using  anthracene  oUs  for  many  years,  but  had  not  been 
employed  at  patent  fuel  or  tar  distilling  works,  neither  had  he  handled  much  pitch. 

No  doubt  in  consequence  of  the  prominence  given  to  epithehomatous  cancer  and  pitch 
ulceration  by  inclusion  in  the  third  schedule  of  the  Workmen's  Compensation  Act,  1906, 
four  reports  were  received  of  cases  in  the  fuel  works  of  Swansea  and  Cardiff  in  which 
operation  had  been  necessary.  Mr.  Owen  Edwards  (Cardiff)  investigated  the  cases  in 
Cardiff  and,  helped  by  Dr.  Paterson  of  that  town,  brought  to  light  four  other  cases.  With 
Mr.  Edwards  I  \'isited  the  fuel  works  in  his  district  and  examined  over  100  men.  No  new 
cases  wepe  discovered,  but  the  skin  of  several  workers  showed  the  characteristic  warts. 
Further  inquiry  by  us  is  in  progress  for  the  purpose  of  securing  generally  throughout  this 
industry  provision  of  sufficient  and  suitable  washing  and  bath  acconamodation,  as  there  is 
general  consensus  of  opinion  that  the  cancerous  condition  can  be  prevented  by  scrupulous 
cleanliness. 

Dr.  Collisj  on  information  received  from  a  certif jang  surgeon,  examined  the  workers  in 
an  engineering  workshop,  some  of  whom  were  suffering  from  eczematous  ulceration  of  the 
hands  and  arms,  attributed  to  a  doubly  refined  Russian  turpentine.  Two  sets  of  men 
suffered  (1)  those  employed  in  wiping  steel  plates  with  turpentine,  and  (2)  those  using  a 
paint  made  up  with  the  same  turpentine.  Of  twenty  men  thus  employed  one-half  were 
or  had  been  affected.  He  recommended  (1)  a  different  turpentine  in  the  mixing  of  the 
paint,  (2)  supply  of  grease  for  removing  the  paint  from  the  sldn  instead  of  the  tm-pentine 
which  was  being  used,  and  (3)  leather  or  other  hand  holders  reaching  half  up  the  forearm 
for  men  engaged  at  the  power  presses. 

In  the  report  of  the  Chief  Inspector  of  Factories  and  Workshops  for 

•This  should  read  "all  occupied  males." 

51 


THE  MORTALITY  FROM  CANCER 

1909  occurs  the  following  description  of  ulceration  of  the  skin  and 
epitheliomatous  cancer  in  the  manufacture  of  patent  fuel  and  grease: 

The  inquiry  into  this  subject  made  by  myself,  in  Cardiff  with  Mr.  T.  Owen  Edwards, 
and  in  Swansea  with  Mr.  J.  H.  Hilditch,  has  been  pubHshed  as  a  separate  report.  The 
number  of  men  examined  was  277.  In  those  most  exposed  to  pitch  dust  the  hair  follicles 
and  sebaceous  glands  become  the  seat  of  a  minute  plug  of  pitch.  Irritation  with  formation 
of  shotty  papules  follows  as  the  secretion  of  the  glands  becomes  obstructed.  These  are  most 
marked  on  the  forehead,  neck,  and  ulnar  side  of  the  forearms.  The  sebaceous  glands, 
especially  behind  the  ear  where  washing  is  less  likely  to  be  thorough,  become  very  promi- 
nent and  comedones  are  generally  noticeable.  Sometimes  there  are  scattered  patches  of 
pigmentation  over  the  arms  with  hyperaemia  and  distension  of  the  small  veins,  or  the 
epithelial  layers  of  the  skin  become  thickened  with  formation  of  definite  warts.  Only 
exceptionally  do  the  warts  take  on  a  malignant  character,  and  then  usually,  but  by  no 
means  invariably,  the  scrotum  is  the  seat  of  the  lesion. 

Suggestions  for  regulations  to  apply  to  occupiers  and  persons  employed  were  made  in 
the  report,  including  (1)  bath  (preferably  douche  bath)  and  washing  accommodation,  (2) 
overalls,  (3)  encasing  of  elevators  and  disintegrating  machines,  and  (4)  wire  goggles  to 
prevent  damage  to  the  eyes  from  flying  particles  of  pitch  in  breaking,  crushing,  etc. 

Protective  Regulations 

Draft  regulations  providing  for  the  sanitary  conduct  of  the  patent- 
fuel  industries  are  referred  to  in  the  report  of  the  Chief  Inspector  of 
Factories  and  Workshops  for  1910: 

Manufacture  of  patent  fuel  and  grease. — As  the  result  of  inquiry  and  report  by  Dr. 
Legge  on  I'.lceration  of  the  skin  and  epitheliomatous  cancer  to  which  the  workers  in  these 
trades  are  liable,  draft  regulations  have  been  drawn  up  for  the  manufacture  of  patent  fuel 
and  issued  to  the  manufacturers  concerned.  Certain  objections  to  these  have  been  re- 
ceived, and  the  Secretary  of  State  has,  in  pursuance  of  s.  81,  appointed  Mr.  A.  H.  Lush, 
barrister-at-law,  to  hold  a  public  inquiry. 

As  regards  the  actual  frequency  of  epithelioma  in  the  patent -fuel  in- 
dustries, the  following  extract  from  the  annual  report  of  the  Chief 
Inspector  of  Factories  and  Workshops  for  1911  is  of  interest: 

Epithelioma. — Eleven  cases  under  this  head  were  reported  from  patent  fuel  works  in  the 
Cardiff  and  Swansea  districts,  but  none  of  them  appear  to  have  been  serious. 

Also  the  following  in  connection  therewith,  from  the  same  report, 
on  the  proposed  draft  regulations  for  the  industries  engaged  in  the 
manufacture  of  patent  fuel  and  grease: 

Following  on  the  receipt  of  objections  to  the  draft  regulations  issued  in  1910  for  this 
industry,  the  Secretary  of  State,  in  pursuance  of  s.  81,  appointed  Mr.  A.  H.  Lush,  barrister- 
at-law,  to  hold  a  public  inquiry,  which  was  opened  at  Cardiff  on  April  26,  1911,  and  con- 
tinued there  and  at  Swansea  and  London  on  thirteen  subsequent  days.  The  Commis- 
sioner* recommended  that  further  consideration  of  the  draft  regulations  should  be  de- 
ferred until  October,  1912,  to  allow  time  for  experiments  which  the  employers,  with  the 
cooperation  of  the  workmen,  were  prepared  to  undertake.  These  will  necessitate  the 
installation  of  baths  on  a  moderate  scale  in  one  or  more  of  the  principal  factories  at  Cardiff 
and  Swansea;  volunteers  from  among  the  men  will  give  the  baths  a  fair  and  complete  trial, 
by  taking  a  bath  daily  for  at  least  a  week.  By  this  means,  it  is  hoped  to  settle  the  question 
whether  the  cleansing  of  the  skin  is  not  more  effective,  and  the  tendency  to  irritation  less, 
if  the  washing  is  done  immediately  after  work,  when  the  skin  is  still  hot  and  the  pores  open. 
Investigation  is  also  being  made  as  to  other  matters,  especially  as  to  the  possibility  of 
adopting  some  form  of  overalls  and  goggles  suitable  to  the  special  conditions  of  this  trade. 

Eczetnatous  Ulcerations 

Some  extended  comments  on  eczematous  ulceration  in  the  manufac- 
ture of  pitch,  brought  out  by  means  of  a  prolonged  inquiry  held  in  South 

'Report  to  the  Secretary  of  State  on  the  draft  regulations  proposed  to  be  made  for  the  manufacture  of 
patent  fuel  (briquettes)  with  addition  of  pitch  (London:  Wymaa  &  Sons,  Ltd.,  1911.     Cd-  6878). 

52 


CANCER  AND  OCCUPATION 

Wales,  are  given  in  the  report,  but  they  can  not  be  included  in  the 
present  abbreviated  account.  They,  however,  should  be  taken  into  con- 
sideration in  connection  with  any  special  study  of  the  subject.  The 
following  portion  of  the  remarks  is  pertinent  to  the  present  discus- 
sion: 

Incidentally  the  inquiry  in  an  unexpected  manner  gave  an  impetus  to  the  subject  of  can- 
cer research.  When  the  draft  regulations  were  first  issued  objection  came  from  two  iron 
works  in  Scotland,  where  briquettes  were  made  as  a  very  subsidiary  business,  that  evidence 
of  warts,  so  common  among  workers  with  gas  works  tar  pitch,  was  absent  in  persons 
handling  blast  furnace  pitch.  This  I  found  was  the  case  and  a  clause  had  to  be  added  to 
the  draft  regulations  expressly  exempting  from  their  scope  factories  or  workshops  in  which 
no  pitch  other  than  blast  furnace  pitch  was  used  in  the  manufacture  of  briquettes.  There 
are  marked  chemical  dififerences  between  the  two  kinds  of  pitch,  depending  partly  on  the 
nature  of  the  coal  from  which  they  are  derived  and  partly  on  the  much  lower  temperature 
of  distillation  of  blast  furnace  than  coal  gas  tar. 

Sanitary  Precautions 

A  special  report  upon  the  progress  made  in  the  South  Wales  patent- 
fuel  works,  following  the  recommendations  of  the  commissioner 
appointed  to  investigate  the  industry  with  reference  to  pitch  ulceration, 
is  referred  to  in  the  annual  report  of  the  Chief  Inspector  of  Factories  and 
Workshops  for  1912.     It  is  stated  that 

Washing  accommodation  has  been  provided,  and  suitable  use  made  of  it  in  some  of  the 
works.  Elevators  for  the  mixture  of  pitch  and  coal  have  been  encased,  and  attempts  have 
been  made  to  relieve  the  skin  irritation  by  the  use  of  lotions  and  ointments.  The  public 
inquiry  will  be  resumed  during  1913. 

A  more  extended  reference  to  the  subject  of  pitch  ulceration  occurs 
in  the  same  report,  being  the  observations  of  the  Medical  Inspector,  as 
follows : 

Dr.  H.  C.  Ross  has  widened  considerably  his  experiments  in  connection  with  this  sub- 
ject.* From  Mr.  W.  J.  A.  Butterfield,  F.  C.  S.,  Secretary  of  the  Metropohtan  Gas  Referees, 
he  received  a  number  of  samples  of  different  kinds  of  pitch,  coal  tar  fractions,  distilling  at 
different  temperatures,  and  from  them  he  concluded  that  the  dangerous  principles  are 
contained  in  the  heavy  oils  of  the  coal  tar.  They  can  not  be  distilled  out  completely  with- 
out ruining  the  pitch,  but  it  would  be  well  if  distillation  were  carried  to  the  utmost  point 
compatible  with  producing  serviceable  pitch.  The  dangerous  principles  are  not  anthra- 
cene or  anthracene  oil,  but  are  probably  some  substances  intimately  mixed  with  them 
which  distil  over  at  the  same  temperatures.  What  they  are  we  do  not  yet  know.  Dr. 
Ross,  after  experiment,  does  not  consider  acridine  to  be  the  cause  of  the  trouble.  For  the 
purpose,  however,  of  ridding  the  tar  of  the  noxious  ingredients,  washing  the  tar,  if  the 
works  concerned  can  undertake  it,  offered,  so  far  as  he  could  see,  much  the  most  satis- 
factory solution  of  the  difficulty.  Tar  distillers,  unfortunately,  represent  that  water  is  their 
greatest  enemy,  and  if  so  treated  processes  of  distillation  would  become  dangerous  from 
the  frothing  of  the  tar  in  the  stills,  as  the  only  means  of  separation  would  be  by  distillation. 

In  later  investigations  with  numerous  samples  of  coal.  Dr.  Ross  has  found  both  auxetic 
and  kinetic  properties  present  in  bituminous  samples,  but  in  no  case  to  anything  Uke  the 
degree  they  are  in  pitch  or  tar. 

Progress  has  been  made  in  the  South  Wales  patent  fuel  works,  following  on  the  Com- 
missioner's recommendations  (to  which  reference  was  made  in  the  last  annual  report). 
Washing  accommodation  has  been  provided,  and  suitable  use  made  of  it  in  some  of  the 
works.  Elevators  for  the  mixture  of  pitch  and  coal  have  been  encased,  and  attempts  made 
to  relieve  the  irritation  caused  to  the  skin,  by  use  of  lotions  and  ointments.  The  pubUc 
inquiry  will  be  resumed  in  1913.  Cases  of  similar  epithehomatous  ulceration  have  been 
reported  during  the  year  from  tar  works. 

The  established  occurrence  of  cancer  as  an  incidental  result  of  the 
manufacture  of  patent-fuel,  or  fuel  briquettes,  consisting  of  coal-dust  and 

*"The  Problem  of  Gasworks  Pitch  Industries  and  Cancer,"  John  Murray,  London,  1912. 

53 


THE  MORTALITY  FROM  CANCER 

pitch  in  the  usual  proportion  of  nine  to  one,  suggests  the  importance  of  a 
careful  study  of  this  industry  in  the  United  States,  since  the  same  has  as- 
sumed considerable  proportions  within  recent  years.  There  were  nine- 
teen plants  engaged  in  the  manufacturing  of  fuel-briquetting  in  1912 
using  as  a  base  anthracite  culm,  bituminous  or  semi-bituminous  slack, 
carbon  residue  from  gas  manufacture  and  peat.  The  binders  used 
varied  also,  and  of  the  nineteen  plants  in  commercial  operation  during 
1912,  ten  used  coal-tar  pitch  as  a  binder,  one  used  asphaltic  pitch,  two 
used  water-gas  pitch  and  four  used  mixed  binders,  the  composition  of 
which  was  not  made  public.  There  appear  to  be  few  recorded  cases  of 
so-called  pitch  cancer  in  this  country,  but  it  is  quite  possible  that  in- 
creasing attention  and  more  careful  observation  may  prove  that  ulcera- 
tions of  the  skin,  and  possibly  cases  of  true  cancer,  occur  in  this  country, 
as  well  as  in  England  and  Wales,  in  connection  with  the  manufacture  of 
patent-fuel,  etc.  It  should  be  stated,  however,  in  this  connection,  that  a 
case  of  multiple  cancer  of  the  skin  in  a  tar-worker,  who  developed  .several 
scores  of  epithelial  lesions  in  various  stages  of  development  upon  the  hands 
and  forearms  and  a  large  epithelioma  upon  the  scrotum,  has  been  re- 
ported by  Dr.  J.  Frank  Schamberg,  of  Philadelphia.  The  case  suggested 
to  Dr.  Schamberg  the  possibility  of  radio-activity  in  coal-tar,  and  to  test 
this  assumption,  according  to  the  Medical  Record,  he  "placed  a  copper 
cent,  a  flat  key  and  a  small  brass  numeral  upon  a  photographic  plate  in  a 
pasteboard  negative  box  lined  with  black  paper.  Upon  the  under 
surface  of  the  lid  he  attached  a  piece  of  cardboard  smeared  with  coal-tar, 
so  that  the  board  faced  downward.  This  box  was  placed  in  a  black 
Japan  tin  cash-box  and  the  latter  was  shut  in  a  dark  closet  for  twenty- 
four  hours.  When  the  plate  was  developed  a  distinct  shadowgraph  of 
the  three  objects  was  seen  on  the  negative."  This  test  of  coal-tar  radio- 
activity is  conceded  by  Dr.  Schamberg  to  be  hardly  conclusive,  but  he 
observes  that  "If  coal-tar  was  proven  to  be  radio-active,  it  would  seem 
that  this  radio-activity  might  be  responsible  for  the  cancer  in  tar- 
workers."  According  to  another  account.  Dr.  Schamberg  examined 
about  twenty  men  whose  work  caused  them  to  be  smeared  with  tar. 
In  the  manufacture  of  tar-paper  the  men's  arms  are  soiled  with  tar  and 
their  clothing  is  more  or  less  saturated.  Most  of  the  men  said  that  they 
suffered  from  time  to  time  with  outbreaks  of  "yellow-heads"  on  their 
arms,  but  these  soon  passed  away.  In  a  number  of  workmen  he  saw 
mild  acne-form  eruptions  on  the  arms  resembling  a  folliculitis.  Five 
workmen  were  found  showing  evidence  of  beginning  or  well-developed 
cancer.* 

Recent  Data  on  Pitch  Ulceration  and  Paraffin  Cancer 

The  subject  of  'pitch  ulceration  is  again  referred  to  in  the  annual  report 
of  the  Chief  Inspector  of  Factories  and  Workshops  for  the  year  1913, 
with  special  reference  to  the  second  report  of  the  Special  Commissioner 
on  the  draft  regulations  for  the  manufacture  of  patent-fuel  with  addition 
of  pitch.  In  the  light  of  practical  experience  it  was  found  that  the 
regulations  were  burdensome  and  not  effective;  and  no  evidence  had 
been  forthcoming  to  prove  that  the  taking  of  baths  was  a  complete 

*An  extended  discussion  on  the  relation  of  tar  and  paraffin  manufacture  to  cancer  occurs  in  the  second 
volume  of  J.  Wolff's  treatise  on  Cancer,  pp.  145-149, 

54 


CANCER  AND  OCCUPATION 

prevention  of  the  evil,  nor  was  it  evident  that  this  requirement  would  be 
suitable  for  all  workmen  under  all  conditions.  It  had  thus  become 
obvious  that  the  objects  of  the  draft  regulations  might  be  better  secured 
by  some  other  method  and  it  was  therefore  intimated  that  the  regula- 
tions might  be  withdrawn  "provided  a  satisfactory  arrangement  could 
be  come  to  for  carrying  out  voluntarily  by  the  employers  certain  im- 
provements which  the  home  office  deemed  essential  for  the  protection 
of  the  workers."  A  new  arrangement  satisfactory  to  all  parties  con- 
cerned was  therefore  made,  including  provision  for  baths,  wash-basins 
and  accommodation  for  clothing,  on  a  scale  which,  in  the  absence 
of  compulsion,  should  be  amply  sufficient  for  all  requirements,  and  also 
the  encasing  of  the  coal-elevators,  as  well  as  those  that  carry  the  mixture 
of  coal  and  pitch,  to  the  reasonable  satisfaction  of  the  Inspector  of 
Factories.  The  number  of  cases  of  pitch  warts,  or  of  epitheliomatous 
cancer  as  a  result  of  them,  which  were  reported  to  the  Factory  Inspection 
Department  during  the  year  1913  was  19,  of  which  3  were  recurrences 
in  persons  previously  reported. 

A  reference  occurs  in  the  Annual  Report  for  1913  to  a  number  of  cases 
of  "Paraffin  Cancer,"  defined  as  a  disease  shale-oil  workers  are  peculiarly 
lialj)le  to  suffer  from.  The  disease  is  briefly  described  as  "having  its 
onset  in  a  variety  of  forms,  i.  e.,  as  an  erythema,  pimples,  papules,  etc., 
these  gradually  dry  up,  forming  hard  crusts,  which,  increasing  in  size, 
form  hard  elevated  wart -like  masses.  As  they  increase  in  size  these 
break  down,  forming  sloughing  ulcers  or  paraflBn  cancers.  He  mentions 
three  cases:  (1)  On  the  dorsum  of  foot,  doing  well  after  operation; 
(2)  scrotal,  so  far  doing  well  after  extensive  operation,  and  (3)  back  of 
wrist,  necessitating  amputation  of  the  right  arm  at  shoulder."  The 
process  is  quite  fully  described  and  the  conditions  are  pointed  out  under 
which  the  disease  may  be  made  subject  to  a  reasonable  degree  of  control. 

The  border-line  between  cases  of  this  kind  and  benign  skin  affections 
due  to  occupational  exposure  is  ill-defined.  An  increasing  amount  of 
trustworthy  evidence  is,  however,  gradually  becoming  available,  which 
would  seem  to  warrant  the  conclusion  that  malignant  disease  as  the 
result  of  occupational  exposure  is  of  more  serious  importance  to  the 
workers  affected  than  is  generally  assumed  to  be  the  case.  * 

Mortality  from  Cancer  in  Different  Occupations 

A  general  discussion  of  cancer  in  relation  to  occupation  occurs  in  the 
treatise  on  "The  Natural  History  of  Cancer,"  by  W.  Roger  Williams. 
On  account  of  the  high  authority  of  Dr.  Williams,  his  observations  are 
given  in  full,  as  follows: 

Although  it  cannot  be  said  that  persons  of  any  rank  or  station  in  life  are  exempt  from 
cancer,  there  are,  nevertheless,  some  remarkable  differences  in  the  incidence  of  the  disease, 
among  the  various  social  strata.  I  have  already  had  occasion  to  point  out  the  much 
greater  prevalence  of  cancer  among  the  well-to-do,  and  among  the  agricultural  community, 
than  among  the  less  prosperous  of  the  industrial  classes  in  our  great  towns,  as  well  as  its 
comparative  rarity  among  paupers,  lunatics,  and  the  prison  population. 

Perhaps  the  most  significant  result  hitherto  attained  by  statistical  investigation  of  this 
subject,  is  that  arrived  at  by  Dr.  Tatham,  who  found  that  the  mortality  from  cancer 
during  the  decennium  1881-1890,  was  more  than  twice  as  great  among  well-to-do  men 

*See  in  this  connection  a  recent  treatise  on  "Occupational  Affections  of  the  Skin,"  by  R.  Prosser  White,  Lon- 
don, 1915,  pp.  26,  85,  93-94;  also  "Diseases  of  the  Skin,"  by  Ernest  Gaucher,  London,  1910,  pp.  186,267,440. 

55 


THE  MORTALITY  FROM  CANCER 

having  no  specific  occupation,  as  among  occupied  males  in  general,  the  respective  cancer 
mortality  ratios  being  96  for  the  former  and  only  44  for  the  latter. 

In  like  manner,  Aschoff  has  shown  that,  in  the  Berlin  population,  cancer  was  of  most 
frequent  occurrence  among  persons  of  independent  means,  living  on  their  income  or  pension. 

All  statistics  show  that  printers,  compositors  and  pressmen  experience  a  very  low 
cancer  mortality,  while  their  death  rate  from  tubercle  and  their  general  mortality  are 
both  very  much  in  excess  of  the  average;  and  this  class  is  notoriously  one  of  the  most 
intemperate  as  regards  alcohol,  etc.,  in  all  modern  communities.  According  to  the 
Twelfth  United  States  Census  Report,  for  the  year  1900,  the  cancer  death  rate  for  this 
class  was  £2  per  100,000  Uving,  the  corresponding  figure  for  pulmonary  tubercle  being  435. 

Another  class  of  workers  but  little  prone  to  cancer  are  the  miners — especially  coal 
miners — and  quarrymen;  the  United  States  statistics  for  this  class  show  a  cancer  death 
rate  of  33;  and  a  phthisis  death  rate  of  120.  Aschoff 's  Berlin  data  place  the  miners  next 
to  the  printers,  in  respect  to  comparative  immunity  from  cancer. 

In  England,  there  are  few  districts  where  cancer  is  less  prevalent  than  in  the  great 
colliery  centres  of  Derbyshire,  South  Wales,  Durham  and  Lancashire;  and  in  the  mining 
and  quarrying  districts  of  Cornwall,  North  Wales  and  elsewhere,  very  low  cancer  death 
rates  also  prevail. 

With  regard  to  the  very  high  mortality  of  chimney-sweeps  from  cancer,  as  shown  by  the 
English  national  statistics,  I  am  inclined  to  think  that  the  calculation  is  based  on  too  small 
a  number  of  cases  to  give  a  reliable  average,  and  is  otherwise  defective;  at  any  rate,  nothing 
of  the  kind  has  been  noted  in  the  United  States,  nor  in  Continental  European  countries.* 

Moreover,  cancer  of  the  corresponding  anatomical  part  in  women — the  vulva — is 
nearly  as  common  as  cancer  of  the  scrotum  in  males;  for,  of  4,628  primary  cancers  in 
females,  104  were  of  the  vulva,  or  2.2  per  cent.;  while  of  2,669  cancers  in  males,  76  were 
of  the  scrotum,  or  2.8  per  cent. 

In  general,  cancer  is  comparatively  infrequent  among  the  working  classes  of  our  large 
towns,  especially  in  the  great  industrial  centres,  and  among  the  cotton  and  textile  opera- 
tives, iron  and  steel  workers,  etc.  On  the  other  hand,  among  the  well-to-do,  the  cancer 
mortality  is  certainly  much  in  excess  of  the  average.  Thus,  among  the  leisured  and  pro- 
fessional classes,  the  United  States  Census  Report — for  1900 — shows  that  high  cancer 
death  rates  prevail,  especially  for  the  clergy,  merchants,  brewers,  hotel  and  restaurant 
keepers,  hotel  servants,  butchers,  agriculturists,  sailors,  commercial  travellers,  car- 
penters, etc. 

Workers  in  soot,  tar,  paraffin,  arsenic,  etc.,  are  specially  prone  to  certain  forms  of 
cutaneous  cancer;  and  it  has  been  reported,  that  those  employed  in  particular  cobalt  and 
nickel  mines  are  prone  to  quasi-malignant  pulmonary  disease. 

There  are  good  reasons  for  believing  that  farm  laborers,  gardeners,  sailors,  and  those 
who  follow  out-of-door  occupations  are  imduly  prone  to  cancer  of  the  lower  lip. 

Of  36  men  with  cancer  of  the  lower  lip  who  came  under  my  observation  in  London 
hospital  work,  5  were  farm  laborers,  5  general  laborers,  3  sailors,  2  bricklayers,  and  1  each 
as  follows:  sadler,  cowman,  blacksmith,  stoker,  worker  in  a  paper  factory,  piano-maker, 
sewerman,  bailiff,  gardener,  brazier,  carpenter,  gas-fitter,  costermonger,  carman,  commer- 
cial agent,  boatman,  waiter,  soldier,  fireman  and  groom. 

The  large  proportion  of  patients  engaged  in  out-of-door  occupations  comprised  in  this 
list  is  very  remarkable;  especially  when  regard  is  had  to  the  sedentary  occupations  followed 
by  the  great  bulk  of  the  London  population,  whence  these  cases  were  drawn. 

With  regard  to  the  influence  of  occupation  on  the  liability  of  women  to  malignant 
disease,  perhaps  the  most  significant  item  hitherto  elicited  is  that  brought  out  by  the 
United  States  Census  Report  for  1900,  which  shows  that  domestic  servants  are  unduly 
prone  to  cancer;  thus,  during  the  age-period  forty-five  to  sixty-five,  their  mortality  from 
this  cause  was  double  the  average;  and,  at  ages  above  sixty-five,  it  was  triple  the  average. 
Cancer  death  rates,  above  the  average,  were  also  noted  among  nurses,  midwives  and  school- 
teachers.f 

With  regard  to  the  female  hospital  patients  with  cancer,  under  my  observation,  most  of 
them  had  been  supported  entirely  by  their  husbands'  earnings;  but  such  of  them  as  had 
worked  for  their  living — whether  married,  widowed  or  single — had  followed  the  following 
occupations  in  142  cases:  thus,  domestic  service,  62  (cook,  17,  charwoman,  13,  house- 

*Chimney-sweeping  as  practised  in  England  is  virtually  an  unknown  occupation  in  the  United  States. 

fAll  of  these  observations  and  conclusions,  especially  with  reference  to  conditions  in  the  United  States, 
must  be  accepted  with  extreme  caution,  on  account  of  the  paucity  of  the  data  considered  and  the  probable 
incompleteness  of  the  census  returns. 

5Q 


CANCER  AND  OCCUPATION 

keeper,  6,  other  forms  of  domestic  service,  20);  needlework,  dressmaking,  etc.,  28;  sick 
nurse  or  midwife,  16;  laundry,  IG;  governess  or  school-teacher,  7;  factory,  7;  shop  assistant, 
4;  barmaid  and  actress,  of  each  1. 

Relative  Occupational  Incidence 

Among  the  more  recent  authors  on  cancer,  a  brief  reference  may  be 
made  to  the  observations  by  Charles  P.  Childe,  in  his  treatise  on  "The 
Control  of  a  Scourge;  or  How  Cancer  is  Curable,"  published  in  1906: 

No  theories  that  I  am  aware  of  have  been  formulated  in  regard  to  occupation  as  a  cause 
of  cancer.  The  following  comparative  mortality  returns,  emanating  from  the  Registrar- 
General,  show  that  no  occupation  is  exempt  from  it,  just  as  no  climate  or  locality  is  exempt 
from  it,  but  do  not  suggest  any  conclusion  as  to  its  origin  being  dependent  upon  occupation 
or  habits  of  life.  All  occupied  males,  44;  all  unoccupied  males,  96;  grocers,  34;  clergy,  35; 
potters,  35;  coal-miners,  36;  farmers,  36;  fishmongers,  42;  medical  practitioners,  43;  black- 
smiths, 45;  fishermen,  46;  porters,  48;  general  laborers,  48;  drapers,  49;  shoemakers,  50; 
dock  and  wharf  laborers,  51;  tobacconists,  51;  plumbers,  53;  inn- keepers,  53;  coal-heavers, 
56;  butchers,  57;  coachmen  and  grooms,  58;  tool  and  scissors  makers,  58;  gas-workers,  59; 
lawyers,  60;  merchant  seamen,  60;  maltsters,  61;  commercial  travellers,  63;  inn  and  hotel 
servants,  65;  brewers,  70;  inn-keepers  in  London,  70;  chimney-sweeps,  156.  An  exanaina- 
tion  of  these  figures  apparently  proves  cancer  to  be  very  haphazard  in  the  selection  of  its 
victims,  except  in  the  case  of  chimney-sweeps,  who,  it  will  be  seen,  more  than  double  any 
other  class.  This  exception  has  generally  been  considered  evidence  that  it  is  connected  in  its 
origin  somehow  wnth  local  irritation  of  various  kinds,  soot  being  the  f oris  et  origo  viali  in 
this  instance.*  Apart  from  this  exception,  the  figures  apparently  leave  us  in  the  dark. 
For  instance,  we  find  clergy  sandwiched  in  between  grocers  and  potters,  medical  practi- 
tioners between  fishmongers  and  blacksmiths,  lawyers  between  gas-workers  and  merchant 
seamen,  and  so  on.  The  tables  seem  to  show  that  it  is  more  a  matter  of  chance  than  any- 
thing else,  and  that  occupation  has  nothing  to  do  with  it. 

Relation  to  Alcoholism 

The  subject  of  cancer  in  its  relation  to  trades  and  occupations  is 
discussed  by  Hollo  Russell,  in  his  treatise  on  "Preventable  Cancer,"t 
in  part,  as  follows : 

A  few  observations,  which  have  been  confirmed  by  all  later  experience,  were  made  forty 
or  fifty  years  ago  on  the  excess  of  cancer  to  which  certain  occupations  were  liable.  It  has 
long  been  known  that  chimney-sweeps  in  England  have  been  attacked  in  a  particular  way, 
and  it  has  been  known  for  some  years  that  gardeners  and  others  who  handle  soot,  tar,  etc., 
are  more  likely  than  others  to  be  attacked  by  cancer  in  the  hand. 

After  discussing  the  comparative  mortality  from  cancer  and  alcohol- 
ism in  specified  occupations,  J  Russell  points  out  that 

The  record  exhibits  very  clearly  the  liability  to  excessive  liquor-drinking  in  all  these 
occupations,  especially  in  brewers,  sweeps,  general  laborers,  and  butchers,  and  may  be 
compared  with  the  high  cancer  rate  of  the  same  trades.  The  excess  in  sweeps  tends  to 
prove  that  the  condition  of  body  and  blood  renders  them  specially  liable  to  the  local 
dangerous  irritation  of  sooty  naatter.     This  explains  the  non-liabihty  of  foreign  sweeps, 

*Since  the  use  of  the  long  brush  for  sweeping  chimneys,  chimney-sweeps'  cancer  is  diminishing. 

t'Treventable  Cancer,"  RoUo  Russell,  London,  1912. 

fThe  relation  of  alcoholism  to  cancer  has  been  discussed  in  "A  Second  Study  of  Extreme  Alcoholism  in  Adults," 
published  by  the  Sir  Francis  Galton  Laboratory  for  National  Eugenics,  London,  IQl^.  The  occasion  for  the 
discussion  was  an  extended  reference  to  the  alleged  excess  in  the  mortality  of  inebriates  from  malignant  disease 
and  tuberculosis,  summed  up  in  the  statement  that  cancer  was  more  than  eight  times  more  common  among 
inebriates  than  among  the  population  of  the  country  at  large.  Subjecting  the  data  to  critical  analjsis,  it  was 
found  by  Mr  De  vid  Heron,  in  charge  of  the  investigation,  that,  quite  to  the  contrary,  the  actual  mortality  from 
cancer  among  the  inebriates  exposed  to  risk  was  less  than  the  expected.  Both  investigations,  however,  are  im- 
paired in  value  by  the  paucity  of  the  data  considered,  there  having  been  only  865  inebriates  exposed  to  risk,  of 
which  ten  suffered  from  cancer  and  [five  died  from  the  disease  during  sentence.  Out  of  2,767  inebriates 
committed  to  the  reformatory,  twenty-four  suffered  from  cancer,  of  whom  ten  died  from  the  disease.  It  would 
obviously  be  unsafe  to  rest  far-reaching  conclusions  one  way  or  the  other  upon  so  small  a  numerical  basis  of  fact. 

57 


TEE  MORTALITY  FROM  CANCER 

who  are  not  particularly  intemperate,  to  sweeps'  cancer.*  In  the  United  States,  sweeps' 
cancer  is  almost  unknown;  in  Belgium,  where  coal  like  the  English  is  used,  there  is  almost 
complete  immunity,  but  great  care  is  taken  to  'prevent  contact  vntk  soot;  in  Germany 
the  practice  is  to  wash  daily  from  head  to  foot. 

An  investigation  of  cancer  statistics  in  Germany  by  the  German  Committee  for  Statis- 
tical Study  was  analyzed  by  Dr.  Hirschberg.  In  men,  cancer  of  the  stomach  preponderates, 
with  413  per  mille;  in  women,  cancer  of  the  breast,  with  243  per  mille  cases.  No  special 
trade  liability  was  found  in  sweeps,  chemical  workers,  etc.  The  agricultural  classes  were 
attacked  more  in  the  skin;  those  engaged  in  the  timber  trade  more  in  the  glands.  Cancer 
of  the  urinary  organs  was  specially  common  among  the  well-to-do.  Acid  wines  and  cider 
seem  to  give  a  predisposition  to  gastric  cancer. 

In  the  report  of  the  Commissioners  of  Prisons  and  the  Director  of  Convict  Prisons  for 
the  year  ending  March,  1911,  it  is  stated:  "Cancer,  the  mortality  of  which  increases  at 
every  age-group  and  for  each  sex  in  the  general  population,  is  again  noticeably  low  in  the 
prison  death  rate,  and  this  is  not  due  to  the  fact  that  prisoners  so  suffering  were  released 
on  medical  grounds,  for  only  three  were  released  for  this  cause  from  local  prisons." 

Cancer  Occurrence  in  Prisons  and  Asylums 

After  calling  attention  to  the  fact  that  on  the  basis  of  oflBcial  reports 
the  cancer  mortality  in  asylums  was  exceptionally  low,  Russell  remarks : 

The  low  rate  of  cancer  in  prisons  and  asylums  is  the  more  worthy  of  consideration  on 
account  of  the  class  from  which  those  detained  are  drawn.  The  prisons  include  a  very 
large  proportion  of  hard  drinkers  and  unsound  bodies.  Yet  the  prison  regime  seems  to 
prevent  the  evil  seeds  which  have  been  sown  from  germinating  abundantly.  Similar  ex- 
periences have  been  related  of  workhouses,  and  many  old  people  who  have  chosen  to  quit 
them  have  very  soon  succumbed  to  common  influences  outside. 

Asylums  contain  an  excessive  number  of  persons  who  have  inherited  or  acquired  con- 
stitutional weaknesses,  and  in  many  cases  tendencies  towards  consumption  or  cancer;  also 
many  alcoholics  who  are  prone  to  these  maladies.  Yet  the  habits  and  rule  of  these  in- 
stitutions reduce  the  cancer  rate  much  below  the  rate  of  the  classes  from  which  they  were 
drawn,  and  below  the  rate  both  of  occupied  and  unoccupied  persons. f 

Cancer  in  the  Petroleum  Industry 

^  Numerous  references  to  cancer  and  non-malignant  skin  eruptions 
among  men  in  certain  trades  occur  in  the  treatise  on  "Industrial 
Poisoning,"  by  Dr.  J.  Rambousek,  published  in  London  in  1913. 
In  connection  with  a  discussion  of  the  petroleum  industry  it  is  pointed 
out  that 

The  occiirrence  of  skin  affections  in  the  naphtha  industry  has  been  noted  by  several 
observers,  especially  among  those  employed  on  the  unpurified  mineral  oils.  Eruptions  on 
the  skin  from  pressing  out  the  paraffin  and  papillomata  (warty  growths)  in  workers  cleaning 
out  the  stills  are  referred  to  by  many  writers.f  Ogston  in  particular. 

Recent  literature  refers  to  the  occurrence  of  petroleum  eczema  in  a  firebrick  and  cement 
factory.  The  workers  affected  had  to  remove  the  bricks  from  moulds  on  to  which  petro- 
leum oil  dropped.  An  eczematous  condition  was  produced  on  the  inner  surface  of  the 
hands,  necessitating  abstention  from  work.  The  pustular  eczema  in  those  employed  only 
a  short  time  in  pressing  paraffin  in  the  refineries  of  naphtha  factories  is  referred  to  as  a 
frequent  occurrence.  Practically  all  the  workers  in  three  refineries  in  the  district  of  Czerno- 
witz  were  affected.  The  view  that  it  is  due  to  insufficient  care  in  washing  is  supported  by 
the  report  of  the  factory  inspector  in  Rouen,  that  with  greater  attention  in  this  matter  on 
the  part  of  the  workers  marked  diminution  in  its  occurrence  followed. 

•The  true  cause  of  the  difference  is  probably  the  non-use  on  the  continent  of  the  English  method  of  chimney- 
sweeping. 

fThe  large  majority  of  persons  in  prison  are,  of  course,  below  the  age  period  of  life  when  cancer  is  most  fre- 
quent. According  to  a  special  investigation,  made  by  me  for  the  purpose,  it  was  found  that  out  of  309  deaths 
from  all  causes  in  American  State  Prisons  during  1914  there  were  only  4  deaths  from  cancer,  or  1.1  per  cent. 

JM itchell,  Jl/«dica/  Nev;s,Yo\.ui,p.  152;  Annalise  d'Hygiene  public.  Vol.  xxiv,p.  500;  Arlidge,  "Diseases  of 
Occupation";  Revue  d'Hygiene,  1895,  p.  160;  Neisser,  Intern.  Uebers.  f.  Gew.-Hyg.,  1907,  p.  96. 

58 


CANCER  AND  OCCUPATION 
In  connection  with  the  coal-tar  industry  it  is  said : 

Workers  coming  into  contact  with  tar  suffer  from  an  inflammatory  affection  of  the  skin, 
so-called  tar  eczema,  which  occasionally  takes  on  a  cancerous  (epithelioma)  nature  similar 
to  chimney-sweeps'  cancer,  having  its  seat  predominantly  on  the  scrotum.  In  lampblack 
workers  who  tread  down  the  soot  in  receptacles  the  malady  has  been  observed  to  affect  the 
lower  extremities  and  especially  the  toes. 

With  reference  to  the  anihne-dye  industry  it  is  stated  that 

In  1903  a  worker  employed  for  eleven  and  a  half  years  in  the  aniline  department  died 
of  cancer  of  the  bladder.  Such  cancerous  tumors  have  for  some  years  been  not  infre- 
quently observed  in  aniline  workers,  and  operations  for  their  removal  performed.  Ley- 
mann  thinks  it  very  probable  that  the  affection  is  set  up,  or  its  origin  favored,  by  anihne. 
This  view  must  be  accepted,  and  the  disease  regarded  as  of  industrial  origin. 

The  frequency  of  tumors  of  the  bladder  among  aniline-workers  is 
briefly  described  in  connection  with  the  coal-tar  industry  as  follows : 

The  first  observations  on  the  subject  were  made  by  Rehn  of  Frankfurt,  who  operated 
in  three  cases.  Bachfeld  of  Offenbach  noticed,  in  sixty-three  cases  of  aniline  poisoning, 
bladder  affections  in  sixteen.  Seyberth  described  five  cases  of  tumors  of  the  bladder  in 
workers  with  long  duration  of  employment  in  anihne  factories.*  In  the  Hochst  factory 
(and  credit  is  due  to  the  management  for  the  step)  every  suspicious  case  is  examined  with 
the  cystoscope.  In  1904  this  firm  collected  information  from  eighteen  anihne  factories 
which  brought  to  light  thirty-eight  cases,  of  which  eighteen  ended  fatally.  Seventeen 
were  operated  on,  and  of  these  eleven  were  still  alive,  although  in  three  there  had  been 
recurrence.  Tumors  were  found  mostly  in  persons  employed  with  aniline,  naphthylamine, 
and  their  homologues,  but  seven  were  in  men  employed  with  benzidine. 

Relation  of  Cancer  to  Injuries 

There  is  a  brief  discussion  of  occupational  cancers  in  Greer's  treatise 
on  "Industrial  Diseases  and  Accidents,"  published  in  London,  1909. 
The  discussion  is  of  exceptional  interest  in  connection  with  the  problem  of 
workmen's  compensation  for  industrial  diseases  and  is  therefore  given 
in  fuU: 

Workers  in  certain  trades  appear  to  be  prone  to  suffer  from  cancer,  as  in  chimney-sweeps, 
tar,  pitch,  grease  and  paraflBn  workers;  possibly  bacon-curers  (Oliver),  aniline  workers 
(Rehn).  The  relation  of  injury  to  the  development  of  cancer  has  received  a  very  great 
deal  of  attention,  the  result  being  that  we  are  in  a  position  to  give  to  traumatism  a  place 
amongst  the  factors  which  influence  the  production  of  malignant  growths.  The  real  cause, 
though  the  object  of  numerous  researches,  has  as  yet  baffled  inquirers.  At  present  we 
have  a  number  of  observations  which  go  to  prove  that  continued  local  irritation  can 
determine  the  development  of  a  malignant  growth.  We  recognize  under  this  head  chimney- 
sweeps' cancer,  tar  cancer,  clay-pipe  cancer.  X-ray  cancer,  etc.  In  this  class  of  super- 
ficial cancers  the  relations  of  cause  and  effect  are  not  widely  apart.  In  the  more  deeply 
seated  growths,  especially  those  taking  origin  in  muscle  and  bone,  the  sarcomata,  we  must 
admit  that  traumatism  may  play  a  causative  part,  though  here  the  relationship  is  not  quite 
so  manifest.  In  this  class  the  history  is  not  usually  that  of  continued  irritation,  but  is  the 
narrative  of  perhaps  a  single  injury.  If  the  deeply-situated  organs,  such  as  the  lung, 
kidney,  stomach,  liver,  intestines,  etc.,  become  affected  with  malignant  disease,  and  there 
is  an  accoimt  of  an  accident,  it  is  very  necessary  before  accepting  the  disease  as  of  trau- 
matic origin  that  the  records  of  the  case  should  f  lu-nish  evidence  that  the  organ  in  question 
was  damaged  at  the  time  of  the  accident.  If  a  long  interval  of  time  separates  the  develop- 
ment of  the  tumor  from  the  accident,  these  records  should  show  a  certain  continuity  and 
sequence  in  the  symptoms  and  signs  following  the  injury  leading  up  to  that  period  in  which 
the  growth  is  revealed.  On  the  whole  question  of  the  traumatic  origin  of  tumors,  Sand  is 
of  opinion  that  to  establish  the  relationship  it  is  necessary  that  the  accident  should  have 
caused  local  lesions,  swelling,  pains,  etc.,  that  the  growth  should  develop  in  the  organ 
involved  directly  or  indirectly  in  the  accident,  that  the  growth  should  appear  within  be- 
tween three  weeks  and  a  year  for  sarcoma  (two  to  six  months  on  an  average),  between  six 

*Munchener  mediziniache  Wochenachrift,  1907, 

59 


TEE  MORTALITY  FROM  CANCER 

weeks  and  five  years  (average  one  to  two  years)  for  cancer,  between  one  month  and  ten 
years  for  glioma  (malignant  disease  of  nerve  structures,  brain,  spinal  cord  and  eyej,  be- 
tween three  weeks  and  two  years  for  other  tumors.  The  patient  should  not  be  the  subject 
of  tumors  of  the  same  class  previous  to  the  accident.  The  traumatic  origin  is  more  likely 
if  the  patient  has  been  healthy  up  to  the  accident.  Youth  is  against  traumatic  origin 
(save  in  sarcomata,  which  are  more  common  in  youth).  Many  authorities  think  that  the 
tumors  described  as  of  traumatic  origin  are  really  latent,  that  is,  that  they  are  dormant 
until  stimulated  into  activity  by  injury.  On  the  point  of  aggravation  of  tumors  by  injury, 
Sand  holds  that  this  would  be  established  under  the  following  conditions:  if  the  accident 
cause,  directly  or  indirectly,  a  tear  or  a  haemorrhage,  etc.,  in  the  growth;  if  new  symptoms 
of  a  serious  nature  show  themselves  within  four  days  of  the  injury;  if  the  development  of 
the  tumor  was  not  at  such  a  stage  that  an  increase  in  activity  was  impending.  A  direct  or 
indirect  traumatism  may  induce  in  a  tumor  a  breaking-up,  and  thus  favor  the  production 
of  metastases  (the  diffusion  of  the  disease  into  other  parts  of  the  body),  but  it  would  most 
probably  take  a  considerable  time  for  these  to  develop,  and  their  relation  to  the  injury 
would  be  difficult  to  establish.  An  injury  can  not  originate  a  metastasis  in  the  wounded 
part,  but  it  may  favor  the  more  rapid  development  of  an  existing  metastasis. 

A  question  may  arise  as  to  whether  in  a  state  of  general  debility  induced  by  an  injury, 
the  normal  resistance  of  the  body  to  the  attacks  of  disease  being  thus  diminished,  malig- 
nant growths  may  evolve  (apart  from  those  which  may  properly  be  considered  to  have  a 
relation  to  local  trauma).?  The  answer  to  this  question  is,  up  to  the  present  we 
have  no  scientific  evidence  to  support  the  view  that  these  growths  arise  under  such  cir- 
cumstances. 

The  subject  of  chimney-sweeps '  cancer  is  briefly  referred  to  by  the 
same  authority : 

Epithelioma  of  the  scrotum  in  chimney-sweeps  is  believed  to  be  due  to  the  long-con- 
tinued irritation  caused  by  the  constant  presence  of  soot  on  the  part.  The  disease  gives 
evidence  of  its  maturity  by  the  appearance  of  warty  growths,  which  may  remain  quiescent 
or  develop  into  ulcers.  These  ulcers  progress  and  destroy  the  whole  scrotum  (purse). 
The  glands  in  the  groin  become  infected,  and  are  eventually  open,  putrefying  sores.  The 
disease  may  ulcerate  into  the  femoral  or  external  iliac  arteries  and  cause  fatal  haemorrhage. 
The  disease  is  curable  by  early  operative  removal. 

Relation  between  Trauma  and  Tumor  Formation 

The  entire  subject  of  malignant  growths  following  injury,  with  special 
reference  to  claims  arising  from  the  result  of  such  injuries,  is  discussed 
by  Magruder  in  a  treatise  published  in  1910.*  The  evidence  presented 
is  largely  in  the  negative.  He  quotes  Cohnheim  to  the  effect  that  the 
"Statistics  concerning  the  relationship  between  trauma  and  tumor 
formation  are  not  convincing,  as  the  tendency  is  too  deeply  rooted  in  the 
human  mind  to  associate  a  local  ailment  with  a  local  cause."  He  also 
quotes  Williams,  writing  in  the  Twentieth  Century  Practice  of  Medi- 
cine, in  the  statement  that  "Those  who  maintain  that  cancers  are  com- 
monly caused  by  traumata,  must  explain  how  it  is  that  men,  who  suffer 
three  times  as  often  from  traumata  as  women,  are,  nevertheless,  only 
about  half  as  liable  to  cancers."  This  conclusion  of  Williams,  however, 
would  hardly  seem  warranted,  since  the  fact  is  overlooked  that  the  excess 
in  cancer  frequency  among  women  is  almost  exclusively  confined  to  the 
generative  organs  and  the  breast.  Magruder  quotes  Sir  Thomas  Oliver's 
suggestion  that  "in  all  cases  of  alleged  traumatic  cancer  leading  to  a 
fatal  termination,  a  post-mortem  examination  should  be  made  in  order 
to  ascertain  whether  what  is  apparent  on  the  surface  of  the  body  is 
the  primary  or  secondary  growth." 

*"Claim9  Arising  from  Results  of  Pcrf-onal  Injuries,"  W.  Edward  Magruder,  M.  D.,  The  Spectator  Com- 
pany, New  York,  1910, 

60 


CANCER  AND  OCCUPATION 

Blast-furnace  Pitch  and  Cancer 

The  subject  of  blast-furnace  pitch  and  cancer  is  briefly  referred  to  in 
The  British  Medical  Journal  of  August  19,  1911: 

Mr.  Perkins  asked  the  Home  Secretary  whether,  in  \-iew  of  the  fact  that  the  spread  of 
cancer  among  workers  with  pitch  was  attributed  to  the  anthracene  contained  in  tar  and 
pitch  derived  from  gas  works,  whereas  tar  and  pitch  derived  from  blast-furnaces  were  free 
from  anthracene,  he  would  take  this  fact  into  consideration  in  the  new  Home  Office  regula- 
tions. Mr.  Churchill  repHed  that  the  fact  that  blast-furnace  pitch  was  much  less  liable  to 
give  rise  to  cancer  was  already  recognized  in  the  draft  regulations,  which  had  been  issued 
by  the  Home  Office,  for  the  manufacture  of  patent  fuel  (briquettes)  with  the  addition  of 
pitch.  Factories  and  workshops  in  which  no  pitch  other  than  blast-furnace  pitch  was 
used  were  specifically  exempted  from  the  regulations.  It  was  not,  however,  certain  that 
anthracene  was  the  constituent  of  ordinary  pitch  to  which  the  prevalence  of  cancer  in  the 
industry  was  due. 

Malignant  Disease  of  the  Lungs  in  Miners 

An  important  contribution  to  the  rather  obscure  subject  of  mahgnant 
disease  of  the  lungs  in  the  miners  of  the  Schneeberg  district  of  Saxony 
occurs  in  the  Journal  of  the  American  Medical  Association,  under  date 
of  June  28,  1913: 

Arnstein  calls  attention  anew  to  the  remarkable  prevalence  of  mahgnant  disease  of  the 
lungs  in  the  miners  in  the  Schneeberg  district  in  Saxony.  The  minerals  mined  are  mostly 
cobalt,  bismuth  and  nickel.  In  1878  Harting  and  Hesse  reported  that  a  lymphosarcoma 
of  the  bronchial  lymph-nodes  or  an  endothelial  sarcoma  was  responsible  for  75  per  cent. 
of  all  the  deaths  among  the  miners.  Arnstein  has  been  investigating  the  subject  anew  and 
found  that  one-third  of  all  the  miners  admitted  to  the  hospital  1907-1911  entered  with  the 
diagnosis  of  cancer  of  the  lung,  and  it  was  given  as  the  cause  of  death  in  44  per  cent,  of  the 
death  certificates.  It  is  probable  that  in  many  cases  tuberculosis  and  possibly  also  pneu- 
moconiosis may  have  been  erroneously  diagnosed  as  cancer  of  the  lung  as  necropsies  are 
rare.  The  local  mining  industry  is  declining,  and  Arnstein  urges  more  extensive  study  of 
the  subject  while  there  is  still  material  for  it.  In  the  two  cases  which  he  was  able  to  ex- 
amine post  mortem,  the  trouble  proved  to  be  chronic  pulmonary  tuberculosis  in  one  case, 
but  in  the  other  true  carcinoma  of  the  lung  with  metastasis. 

Cancer  among  Tar  and  Paraffin  Workers 

The  following  observations  on  occupational  cancers  are  from  an  address 
on  "Occupational  Diseases,"  by  Dr.  W.  GUman  Thompson,  published 
in  the  Medical  Record,  New  York,  February  3, 1912: 

Tar  and  paraffin  workers  develop  a  similar  eruption  which  may  last  several  months  and 
then  change  to  the  so-called  "tar  itch."  This  is  accompanied  by  hyperkeratosis  and  in- 
creased activity  of  the  sebaceous  glands,  forming  plaques  and  crusts,  with  the  further 
development  of  multiple  warts,  one  or  more  of  which  degenerate  into  malignant  growths. 
The  disease  aft'ects  chiefly  the  hands,  forearms,  and  scrotum.  It  progresses  slowly  and  in 
many  instances  no  recurrence  takes  place  after  removal  of  the  epitheUoma.  Oliver  cites 
the  case  of  a  man  aged  58  who  had  worked  among  coal-oil  and  tar  products  for  thirty  years. 
He  presented  numerous  indurated  patches,  some  of  which  had  ulcerated,  as  well  as  multiple 
black  warts  and  scars,  the  remains  of  old  ulcers.  His  son,  27  years  old,  following  the  same 
employment,  developed  a  malignant  growth  of  the  forearm  which  necessitated  amputation. 
Metastases  of  the  axillary  and  cervical  lymph-nodes  took  place,  the  patient  succimibing  to 
secondary  carcinosis. 

Cancer  in  chimney-sweeps  has  been  reported  chiefly  from  England.  The  soot  produces 
a  chronic  irritation  of  the  skin  and  when  retamed  in  such  regions  as  the  folds  of  the  scrotum 
causes  warty  growths  which  become  epithehomatous.  In  some  instances  the  hands,  arms, 
and  thighs  have  been  involved.  The  incidence  of  scrotal  cancer  has  been  markedly 
reduced  by  the  use  of  machinery  to  clean  chimneys.  It  is  reported  that  gardeners  who 
employ  soot  for  the  protection  of  plants  from  slugs  similarly  show  the  effects  of  this  irri- 
tant in  the  development  of  malignant  growths  of  the  hands. 

61 


THE  MORTALITY  FROM  CANCER 
Comparative  Mortality  from  Cancer  among  Chimney-sweeps 

Arlidge,  in  his  work  on  "The  Hygiene,  Diseases  and  Mortality  of 
Occupations,"  published  in  London  in  1892,  observes  regarding  chimney- 
sweeps' cancer:* 

But  the  disease,  par  eminence,  attaching  to  their  calling  is  epithelial  cancer.  Dr.  Ogle 
discovered,  from  his  statistics,  that  "of  242  deaths  of  chimney-sweeps,  no  less  than  forty- 
nine  were  due  to  some  form  of  malignant  disease.  This  gives  202  deaths  from  this  cause 
to  1,000  deaths  from  all  causes;  whereas  the  proportion  of  deaths  from  malignant  disease 
to  deaths  from  all  causes,  among  all  males  from  25  to  65  years  of  age  in  England  and 
Wales,  is  only  36  in  1,000;  so  that,  even  if  the  total  mortality  of  sweeps  were  simply  equal 
to  that  of  all  males,  their  mortality  from  malignant  disease  would  be  more  than  five 
times  as  much  as  the  average.  But  the  mortality  of  chimney-sweeps  .  .  .  is  50 
per  cent,  higher  than  the  average,  so  that  the  liability  of  chimney-sweeps  to  mahgnant 
disease  is  about  eight  times  as  great  as  the  average  liability  for  all  males.  These 
figures  scarcely  support  the  belief  expressed  by  some  authorities  that  improvements  in 
the  art  and  habits  of  sweeps  have  caused  this  disease  to  be  comparatively  infrequent 
among  them."  Of  the  forty-nine  cases  of  deaths  by  cancer  returned,  the  scrotum  and 
adjacent  parts  were  the  seat  of  the  lesion  in  twenty-three;  in  thirteen  the  organ  affected  was 
not  stated;  but  in  seven  of  them  the  malady  was  in  internal  organs,  and  the  rest  in  the  face, 
hip,  orbit,  palate,  or  neck.  The  consoling  belief  that  sweeps'  cancer  is  becoming  a 
scarce  phenomenon,  since  the  application  of  the  special  Acts  of  Parliament  controlling 
their  work,  is  also  somewhat  rudely  shaken  by  Mr.  Butlin,  of  St.  Bartholomew's 
Hospital,  who,  in  his  work  on  cancer,  aflBrms  that  numerous  instances  are  to  be  met  with. 

Cancer  Frequency  in  Gardening  and  Agriculture 

An  important  reference  to  cancer  as  an  occupational  disease  among 
gardeners  occurs  in  the  treatise  on  "Industrial  Diseases,"  by  Weyl, 
published  in  1908. f  This  discussion  refers  particularly  to  market 
gardeners,  and  apparently  leans  towards  the  view  that  cancer  is  an 
infectious  disease  and  transmitted  to  gardeners  in  connection  with  the 
handling  of  infected  earth  or  water,  as  the  case  may  be.  There  is  also  a 
reference  in  this  discussion  to  the  proportionate  mortality  from  cancer 
among  men  employed  in  different  occupations  in  the  city  of  Berlin  during 
the  two  years  1897-99,  the  percentage  of  cancer  deaths  in  the  mortality 
from  all  causes  having  been  as  follows:  Printers,  3.18,  chemical  industry, 
3.85, miners  and  stone-workers, 4.65,  metal-workers,5. 08, machinists,  5.69, 
paper  and  leather  industry,  6.18,  wood-working  industries,  6.45,  com- 
mercial occupations,  including  insurance,  6.81,  building,  6.96,  clothing 
industry,  7.45,  textile  industry,  7.49,  food  industries,  7.67,  transporta- 
tion industries,  8.08,  shipping,  9.07,  gardeners,  11.25,  agriculture,  25.03. 
It  is  pointed  out  in  this  connection  that  in  gardening  and  agriculture, 
respectively,  35.3  per  cent,  and  33.4  per  cent,  of  the  population  are  above 
age  40;  but  it  is  observed  that  this  percentage  is  exceeded  in  many  of 
the  occupations  in  which  the  proportionate  mortality  from  cancer  is 
considerably  less. 

Reference  is  also  made  in  this  work  to  the  report  of  the  German  Com- 
mittee on  Cancer  Research,  on  the  basis  of  the  cancer  census  of  Octo- 
ber 15,  1900.  The  proportion  of  patients  suffering  from  cancer  of  the 
skin  was  found  to  be  exceptionally  large  among  agricultural  workers, 
and  the  conclusion  is  advanced  that  this  was  the  result  of  contact  with 
infected  earth.     Mention  is  made  of  the  rather  interesting  fact  that  the 

*An  extended  historical  discussion  of  chimney-sweeps'  cancer  occurs  in  the  chapter  on  chronic  irritation,  etc., 
in  J.  Wolff's  treatise  on  Cancer,  Vol.  ii,  p.  141,  el  seq. 

f'Handbuch  der  Arbeiterkrankheiten,"  Dr.  Theodor  Weyl,  Jena,  1908,  p.  625. 

62 


CANCER  AXD  OCCUPATION 

old  garden  city  of  Erfurt,  with  a  constantly  diminishing  mortality  from 
all  causes,  had  experienced  a  constant  increase  in  the  mortality  from  can- 
cer. The  rate  per  10,000  living  increased  from  5.6  for  the  period  1880-84 
gradually  to  9.8  during  the  five  years  ending  with  1904.*  It  was  held, 
however,  that  this  increase  could  not  be  connected  with  employment  in 
gardening  or  truck-farming. 

Cancer  in  Animals  and  Plants 

In  the  study  of  the  occupational  incidence  of  cancer  the  possible  para- 
sitical origin  of  the  disease  requires  consideration.  The  subject  has 
been  quite  carefully  investigated  by  C.  E.  Green  in  his  treatise  on  "The 
Cancer  Problem:  A  Statistical  Study,"  published  in  Edinburgh  in  1911. 
Green  has  raised  the  question  as  to  whether  there  are  any  conditions  in 
the  trades  showing  the  highest  cancer  death  rates  which  would  encourage 
the  growth  of  a  parasite  akin  to  the  myxomycetes,  which  are  of  doubtful 
relationship  either  to  animals  or  to  plants.  He  tries  to  connect  the 
cancerous  growth  in  plants  with  the  corresponding  growth  in  the  human 
body  and  in  this  connection  points  out  that 

Agriculturists,  however,  have  suffered  severely  from  the  ravages  of  Plasmodiophora 
and  one  fact  in  particular  is  given  in  agricultural  text-books  as  the  result  of  their  practical 
experience,  viz.,  that  whenever  manures  are  used  which  have  been  dissolved  in  sulphuric 
acid  the  disease  is  almost  certain  to  occur.  This  fact  seems  very  important.  Of  its  ac- 
curacy there  can  be  no  doubt,  since  the  Board  of  Agricultm-e  goes  so  far  as  to  distribute 
leaflets  gratis  all  over  the  country  warning  farmers  that  manures  dissolved  in  sulphuric 
acid  have  a  marked  tendency  to  encourage  the  disease. 

Coal-soot  as  a  Cause  of  Cancer 

Green,  therefore,  concludes  that  such  manures  have  a  stimulating  effect 
upon  the  plasmodiophora  and  that  cancer  is  of  exceptional  frequency  in 
occupations  which  encourage  the  gro^i:h  of  a  possible  cancer  parasite 
under  the  conditions  stated.  He  does  not  accept  the  mechanical  irritant 
theory  as  entirely  conclusive,  but  he  inclines  to  the  belief,  with  special 
reference  to  chimney-sweeping  and  similar  occupations,  "that  soot,  or 
some  product  of  combustion,  is  an  active  agent."  He,  therefore, holds  that 

Ordinary  coal  soot  has  a  deleterious  effect  upon  the  leaves  of  plants,  and  this  was 
formerly  ascribed  to  mechanical  irritation  or  to  the  blocking  of  the  stomata  through 
which  the  plants  breathe.  Stockhardt,  however,  proved  this  to  be  wrong  by  an  experi- 
ment, eighty-six  times  repeated,  in  which  he  filled  a  glasshouse  with  an  atmosphere  of  soot 
from  burnt  benzine  so  thick  that  the  contours  of  the  plants  could  not  be  seen,  and  that  the 
leaves  were  almost  black.  No  disturbance  of  growth  could  be  detected,  and  the  leaves 
were  afterwards  as  fresh  as  those  outside.  The  pure  carbon  soot  from  the  benzine  had  no 
effect,  while  coal  soot  had. 

For-  the  same  reasons  he  argues  that  the  carbon  in  coal  does  not  cause 
cancer  in  miners,  which  seems  to  be  fairly  well  established  by  the  avail- 
able statistics.  In  continuation  of  his  interesting  argument  Green  re- 
marks : 

The  fact  that  coal  soot  has  some  relation  to  the  sweeps'  high  mortality  is  also,  I  think, 
indicated  by  the  part  of  the  body  chiefly  affected,  as  shown  by  a  table  in  the  Registrar's 
latest  report.  This  table  shows  that  in  30  per  cent,  of  the  deaths  the  scrotum  and  its 
adjacent  parts  are  those  affected.  Now,  the  face  of  a  working  sweep  will  always  be  found 
to  be  covered  with  light  powdery  soot,  while  his  hands  and  nails  are  absolutely  black  and 
coated.  The  extremities  are  not  liable  to  malignant  disease,  but  these  soot-ingrained 
hands  must  for  ob^^ous  reasons  several  times  in  a  working  day  come  in  contact  with  the 

*The  cancer  death  rate  in  Erfurt  in  1910  was  12.0  per  10,000  of  population. 

63 


THE  MORTALITY  FROM  CANCER 

susceptible  parts  which  are  associated  with  "sweeps'  cancer."  If  soot,  then,  be  an  active 
agent  in  producing  mahgnant  disease,  as  is  shown  by  the  appalhng  mortality  among 
chimney-sweeps  and  by  other  indications,  while  coal-dust  has  no  effect  upon  the  coal- 
miner,  it  is  obviously  of  importance  to  consider  what  soot  contains  which  coal  does  not. 

Green  explains  in  this  connection  that  coal-soot  is  chiefly  composed 
of  finely  divided  carbon,  but  that  it  contains  also  a  considerable  propor- 
tion of  sulphate  of  ammonia;  and  further,  that  since  coal  contains  sul- 
phur and  nitrogen,  sulphurous  acid  is  evolved  in  the  process  of  combus- 
tion, which  combines  to  form  sulphate  of  ammonia,  the  existence  of 
which  in  large  quantities  in  soot  has  led  to  its  extensive  use  as  a  fertilizer 
by  farmers  and  gardeners.* 

Paraflfin- workers 

Perplexed  by  the  apparent  difficulty  that  in  sulphate  of  ammonia, 
or  the  sulphurous  acid  which  goes  to  compose  it,  is  a  causative  factor, 
it  was  difficult  to  explain  how  paraffin  had  induced  cancerous  growths 
among  paraffin-workers  in  several  well-authenticated  cases.  The 
question  confronting  him  was  to  ascertain  whether  there  was  anything 
in  common  between  commercial  paraffin  and  soot.  He  observes  with 
reference  thereto: 

When  we  examine  the  practical  methods  of  paraffin  refining  we  find  that  in  order  to 
remove  the  oily  bases  it  has  been  found  in  practice  that  an  acid  treatment  of  the  finished 
oil  is  necessary.  It  is  not  possible  to  remove  the  whole  of  these  bases  by  one  or  even  two 
acid  treatments,  but  the  oil  must  be  shaken  vp  with  acids  a  number  of  times.  All  kinds  of 
acids  have  been  tried,  but  the  results  of  numerous  experiments  have  proved  sulphuric  acid 
to  be  the  only  one  suitable  for  this  work.  It  is  specially  pointed  out  in  Redwood's  Mineral 
Oils  as  of  the  utmost  importance  that  all  such  sulphuric  acid  treated  oils  must  be  allov/ed 
to  settle  until  as  thoroughly  freed  from  this  acid  tar  as  possible. 

In  removing  the  impurities  the  sulphuric  acid  must  form  various  sulpho-acids  which 
must  frequently  be  present  in  the  paraffin  after  the  operation.  It  would  be  a  difficult 
matter  to  say  what  were  the  sulpho-acids,  as  there  might  be,  of  course,  fifty  different  varie- 
ties, entirely  depending  on  what  the  impurities  were.  There  would  certainly  be  no  sulpho- 
acids  of  the  paraffin  itself,  as  this  remains  unacted  on,  and  it  is  only  impurities  that  are 
acted  on. 

One  impurity  which  is  bound  to  exist,  however,  is  ammonia — since  the  method  of 
separation  of  ammonia  water  from  the  crude  oil  is  a  very  rough  and  ready  one — and  we  are 
driven  to  the  result  that  even  in  refined  paraffin,  as  in  soot,  sulphate  of  ammonia  and 
sulpho-adds  must  often  exist. 

Brewers 

These  extracts  have  been  given  in  full,  since  they  are  not  only  of  in- 
terest in  connection  with  the  subject  under  consideration  but  also  as  an 
indication  of  the  direction  which  scientific  inquiries  of  this  kind  are 
bound  to  take.  The  conclusions  by  Green  are  apparently  confirmed  by 
his  subsequent  investigations,  and  particularly  with  reference  to  brewers, 
who  exhibit  a  high  mortality  figure  from  cancer  and  who  in  a  branch  of 
their  work  are  exposed  to  the  effects  of  soot  accumulations.  Additionally 
thereto  the  brewer  is  said  to  be  exposed  in  the  constant  handling  of 
"sulphured"  hops,  the  sulphur  being  used  for  bleaching  purposes. 

*There  is  a  brief  reference  to  cancer  in  one  of  the  papers  on  the  "Influence  of  Smoke  on  Health,"  published 
by  the  Mellon  Institute  of  Industrial  Research,  Pittsburgh,  Pa.,  1914.  After  restating  the  generally  accepted 
view  that  "soot  has  for  many  years  been  more  or  less  fancifully  believed  to  create  a  predisposition  towards  the 
production  of  cancerous  growth  among  workmen  who  are  brought  into  contact  with  it"  and  an  extended  refer- 
ence to  recent  observations  by  Sir  Thomas  Oliver,  the  report  concludes  that  "it  is  scarcely  conceivable  that  the 
amount  of  soot  in  the  air  of  industrial  towns  is  sufficient  in  amount  to  be  an  exciting  cause  of  cancer,  as  it 
might  possibly  be  in  the  case  of  chimney-sweeps."     (See,  however,  discussion  of  chemical  industry,  page  65.) 

64 


CANCER  AND  OCCUPATION 

Furriers  and  Skinners 

With  special  reference  to  furriers  and  skinners.  Green  calls  attention 
to  the  instructive  fact  that  these  occupations  rank  high  in  the  mortality 
from  cancer,  while  tanners  invariably  rank  very  low.  The  cause,  he  ex- 
plains, must  naturally  be  due  to  some  essential  differences  in  the  method 
of  preparing  skins  for  furs  and  for  leather.  The  facts  are  not  fully  set 
forth,  but  apparently  the  irritant  is  the  sulphuric  acid  contained  in  the 
alum  used  for  skin-preserving  purposes.  He  remarks  that  nearly  all  furs 
have  to  be  dyed,  and  that  the  mordant  used  is  chiefly  sulphuric  acid. 

Seamen 
Concerning  seamen  it  is  said : 

Seamen  have  shown  a  great  increase  in  their  cancer  mortality,  due  apparently  to  the 
increase  of  steamers  and  the  decrease  of  sailing  ships.  The  fact  that  they  have  a  higher 
mortality  figure  than  fishermen  seems  to  me  to  be  due  to  this  and  to  their  stuffy  and 
smoky  quarters.  Fishermen  do  not  so  often  sleep  on  board;  indeed,  the  greater  number 
never  do. 

Tinplate-workers 

Concerning  tinplate  manufacture  he  observes : 

What  element  in  the  manufacture  of  tinplate  can  cause  this  very  high  mortality  figure? 
If  my  theory  is  correct,  this  would  explain  it:  "Before  'tinning,'  the  plates  are  called  black 
plates.  When  the  iron  has  been  cut  to  the  required  size  the  plates  are  'pickled,'  i.  e., 
they  are  immersed  in  hot  sulphuric  acid." 

Lead-workers 
Also  with  reference  to  lead-workers  the  observations  are  of  special 
interest : 

Here  we  have  a  close  connection  with  sulphurous  acid.  It  is  pointed  out  in  the  last 
report  of  the  Registrar-General  that  the  mortality  of  lead-workers  had  decreased  since 
1890.  Now,  until  recent  years  only  a  small  quantity  of  lead  was  obtained  from  any 
other  ore  than  galena,  which  is  a  sulphide  of  lead.  \Mien  galena  is  smelted,  much  of 
the  sulphur  goes  to  form  sulphurous  acid,  which  escapes  as  a  gas.  There  remain  in  the 
hearth  of  the  furnace  oxide,  sulphate,  and  sulphide  of  lead,  which  react  upon  each  other, 
forming  sulphurous  acid  and  metallic  lead. 

Rubber- workers 

And  concerning  India  rubber-workers: 

The  connection  here  is  at  first  sight  obsciu-e,  but  the  fact  remains  that  alum  and 
sulphuric  acid  are  constantly  used  to  effect  the  coagulation  of  the  juice,  and  it  is  pointed 
out  in  the  Encyclopedia  Britannica  (India  rubber)  that  traces  of  these  remaining  in  the 
rubber  constantly  work  mischief  in  it. 

Chemical  Industry 

Green's  treatise  includes  a  brief  discussion  of  the  incidence  of  cancer  in 
chemical  manufactures,  which,  of  course,  include  employments  with  an 
exceptional  degree  of  exposure  to  sulphuric  acid  fumes,  etc.,  and  as  re- 
gards general  occupations  in  London,  for  which  the  mortality  figure  is 
above  the  average,  he  explains  that  this  is  probably  due  to  the  enor- 
mous amount  of  sulphurous  acid  in  the  atmosphere.  He  incidentally 
mentions  the  frequency  of  cancer  among  guano-workers,  quoting  from 
the  new  edition  of  Bryant  and  Buck's  Surgery,  the  occurrence  being  at- 
tributed to  the  fact  that  since  the  rich  deposits  have  been  largely  worked 
out  the  stores  now  drawn  upon  are,  in  many  cases,  compact  and  rocky 
in  texture,  and  require  to  be  disintegrated  and  treated  with  sulphuric 
acid.     He  therefore  concludes  that  "if  sulphurous  acid  or  sulpho-acids 

65 


THE  MORTALITY  FROM  CANCER 

have  no  connection  with  cancer  I  have  stumbled  across  an  extraordi- 
nary series  of  coincidences." 

X-ray  Workers  and  X-ray  Dermatitis 
Perhaps  no  problem  in  occupational  cancer  has  attracted  more  atten- 
tion than  X-ray  carcinoma.  An  analysis  of  forty-seven  cases  is  pre- 
sented by  Dr.  C.  A.  Porter,  of  the  Harvard  Medical  School,  in  the  Fifth 
Report  of  the  Cancer  Commission  of  Harvard  University.  The  fol- 
lowing brief  observations  are  from  this  important  contribution  to  the 
subject : 

Though  the  harmful  results  of  continuous  exposure  to  the  X-rays  were  unknown  to  the 
early  workers  in  this  field,  it  would  seem  that  unwittingly  they  have  given  us  the  best 
demonstration  yet  known  of  the  artificial  or  experimental  production  of  cancer.  It  is 
unlikely  that  old  age  itself,  with  its  accompanying  skin  atrophies,  even  if  combined  with 
exposure  to  such  various  noxious  influences  as  sea  life,  raw  winds,  powerful  actinic  rays, 
soot  or  paraffin,  would  give  such  an  example  of  malignant  skin  degeneration  as  seems  so 
frequently  to  result  from  protracted  exposure  to  the  X-ray.  ^Mien  it  is  remembered  that 
these  lesions  have  been  produced  in  young  men  at  an  age  when  skin  cancer  is  extremely 
rare,  its  occurrence  is  all  the  more  striking. 

Regarding  an  apparently  effective  method  of  protection  for  X-ray 
workers  it  is  said: 

An  accidental  discovery  in  the  case  of  J.  G.,  Case  XVIII.,  seems  to  show  the  value  of 
protection  during  the  early  years  of  work,  and  the  lack  of  harmful  influence  to  recent 
exposures  with  proper  precautions.  A  broad  gold  ring  was  worn  during  the  first  two  years 
of  work  on  the  ring  finger  of  the  left  hand.  This  was  subsequently  removed.  The  whole 
dorsum  of  the  hand  shows  the  characteristic  changes,  while  the  skin  protected  by  the  ring 
remains  to  this  day  perfectly  normal.  The  immunity  which  even  fight  clothing  offers  is 
shown  by  the  rarity  or  slight  degree  of  dermatitis  above  the  cuffs,  and  in  those  parts  of  the 
body  protected  by  clothing.  It  would  seem,  therefore,  in  view  of  this  immunity  from 
slight  covering,  that  not  the  X-rays  themselves,  but  other  emanations  from  the  tube  are  to 
be  held  chiefly  responsible  for  the  burns  and  the  chronic  dermatitis. 

The  subject  attracted  the  attention  of  Green,  who  remarks; 

In  this  imperfect  survey  of  the  trade  and  occupational  incidence  of  the  disease  I  would 
venture  to  make  a  suggestion  regarding  what  is  caUed  X-ray  cancer,  which  so  commonly 
follows  a  dermatitis  on  the  hands  of  X-ray  workers.  It  is  certainly  one  of  the  most  puzzfing 
aspects  of  the  whole  cancer  problem  that  X-rays  should  cure  rodent  ulcer  and  yet  induce 
epithelioma  on  the  fingers  of  the  operators  of  these  rays.  If,  as  stated  before,  the  Plas- 
modia of  myxomycetes  are  killed  by  exposure  to  light  of  moderate  intensity,  it  is  quite 
intelligible  that  X-rays  should  cure  cancer,  but  quite  iminteUigible  that  they  should 
cause  it. 

The  X-rays  admittedly  cause  a  dermatitis  and  thereby  diminish  the  resistance  of  the 
epithefium.  It  should  not  be  forgotten,  however,  that  most  X-ray  operators  have  to 
prepare  many  skiagraphs  and  to  develop  negatives.  This,  in  my  opinion,  is  the  cause. 
Fixing  plates  by  means  of  hypo-sulphite  with  fingers,  the  skin  resistance  of  which  is  already 
weakened,  is  much  more  likely  to  cause  the  epithelioma  than  the  rays  themselves.  These 
would  only  indirectly  be  concerned. 

As  bearing  upon  the  protective  means  suggested  by  Dr.  Porter  it 
appears  that  Dr.  Menard,  director  of  the  radiography  section  of  the 
Cochin  Hospital,  has  devised  a  glove  which  will  avert  all  danger  to  the 
operating  physician  when  using  the  X-ray.  It  would  carry  this  discussion 
entirely  too  far  to  review  in  detail  the  not  inconsiderable  evidence  of 
Roentgen-ray  injuries,  with  reference,  of  course,  to  cancer  growth.  The 
risk,  no  doubt,  is  especially  great  in  the  manufacture  of  X-ray  appa- 
ratus, and  particularly  X-ray  tubes.  The  subject  has  been  discussed 
under  the  title  "Roentgen-rays  and  Dermatitis,"  by  Sir  Thomas  Oliver 
in  his  evidence  (Q.  10,625),  before  the  Committee  on  Industrial  Diseases. 

66 


CANCER  AND  OCCUPATION 

In  view  of  the  obvious  risk  to  X-ray  workers,  the  following  extract 
from  the  Medical  Record  of  August  8, 1903,  is  included: 

G.  Holzknecht  and  R.  Griinfeld  have  devised  a  protective  covering  for  the  skin  for  use 
during  the  application  of  the  Roentgen  rays.  It  consists  of  a  sheet  of  tin  which  is  covered 
on  both  sides  with  a  thin  layer  of  hard  rubber.  The  plate  thus  made  may  be  of  any  size 
and  shape  desired  and  perforated  by  as  many  apertures  as  wished.  It  is  very  flexible  and 
may  be  easily  adapted  to  the  various  curvatures,  etc.,  of  the  body.  It  is  light  and  easy  to 
handle,  and  may  be  sterilized,  washed,  or  heated  without  damage.  Its  extended  use 
shows  that  it  affords  a  complete  protection  to  the  healthy  skin  from  the  burning  and  other 
armoyances  which  frequently  attend  the  appUcation  of  the  Roentgen  rays. 

Among  the  more  suggestive  cases  of  fatal  injuries  from  X-ray  expo- 
sure in  the  medical  profession  a  brief  reference  may  be  made  to  the 
death  of  Dr.  B.  E.  Baker,  of  Hartford,  who  died  from  injuries  due  to 
exposure  to  the  X-rays  in  the  course  of  experimental  work  in  1913. 

The  Medical  Record  of  March  29,  1913,  quoting  from  the  Journal  for 
Insurance  Medicine  *  notes  the  case  of  an  electrician  as  follows : 

The  electrician  was  employed  for  fifteen  years  in  the  X-ray  room  of  an  orthopedic 
clinic  and  had  suffered  from  a  chronic  affection  of  the  skin  of  the  hands  and  face  resulting 
irom  constant  exposure  to  the  rays.  He  was  finally  incapacitated,  and  applied  to  his  trade 
union  for  the  indemnity  for  accidental  injury  during  employment.  The  union  refused 
such  indemnity,  stating  that  the  injury  complained  of  was  not  due  to  any  accident,  but  was 
really  an  occupational  disease,  not  to  be  indemnified  according  to  the  terms  of  insurance. 
An  appeal  to  the  courts  was  decided  in  favor  of  the  union's  interpretation  of  the  agreement. 

The  Medical  Record  also,  under  date  of  April  5,  1913,  cites  the  case  of 
the  death  of  Dr.  Charles  Lester  Leonard,  professor  of  Roentgenology 
in  the  Philadelphia  Polyclinic  and  College  for  Graduates  in  Medicine, 
and  one  of  the  pioneers  in  this  special  field  of  work.  Dr.  Leonard  some 
years  ago  first  lost  several  fingers  from  one  hand,  and  later  on  the 
entire  hand  was  sacrificed,  it  being  subsequently  found  necessary  to 
remove  the  forearm  so  as  to  check  the  advancing  effects  of  the  X-ray 
burns. 

Radio-active  Substances  and  Cancer 

The  study  of  radio-active  substances  in  their  relation  to  cancer  and 
occupation  offers  a  field  of  considerable  promise.  The  admirable  ex- 
perimental inquiry  by  Lazarus-Barlow  suggests  results  of  considerable 
practical  value.  With  regard  to  substances  commonly  supposed  to  be 
casually  related  to  carcinoma,  this  author  states  that 

Numerous  samples  of  clay  pipe,  soot,  pitch,  paraffin  wax,  metallic  arsenic,  arsenious 
oxide,  betel  nut,  cholesterin  gall  stones,  pigment  gall  stones,  renal  and  vesical  calcuH,  have 
been  examined  skotographically,  the  calcuh,  renal,  bihary,  and  vesical,  being  made  the 
subject  of  an  extended  research  by  Dr.  Colwell.  Skotographic  effect  was  exhibited  by  one 
sample  of  soot  out  of  two  examined,  by  betel  nut  on  all  of  numerous  occasions,  by  each 
of  twenty-three  specimens  of  cholesterin  gall  stones,  more  or  less  "pvu-e,"  in  three  out  of 
four  samples  of  pigment  gall  stones  examined,  the  effect  being  always  very  slight  as  com- 
pared with  the  action  of  the  cholesterin  calcuh,  and  by  thirty  out  of  thirty-eight  vesical 
calcuh.  Metalhc  arsenic  and  arsenious  oxide  produced  effects  upon  the  photographic 
plates,  but  inasmuch  as  the  films  showed  alteration  before  development  the  action  cannot 
be  regarded  as  skotographic.  On  the  other  hand,  none  of  nine  specimens  of  clay  pipe,  of 
numerous  samples  of  paraffin  wax,  of  four  samples  of  pitch  from  different  localities,  of 
several  specimens  of  coal,  yielded  the  sUghtest  trace  of  skotographic  action. f 

Even  though  the  evidence  was  negative,  it  would  seem  well  worth 
while  to  carry  on  further  experimental  research  along  the  lines  suggested. 

*Zeitschrift  fiir  Versicherungs  Medizin,  Vol.  v.  No.  12, 
XThe  BritUk  Medical  Journal,  June  19,  1909. 

67 


TEE  MORTALITY  FROM  CANCER 
Cancer  and  Exposure  to  Light 

The  relatively  high  frequency  of  cancer  among  seamen  and  fishermen 
would  seem  to  support  the  theory  advanced  by  Wilfred  Watkins  Pitch- 
ford,  M.  D.,  Government  Pathologist  of  Natal,  in  an  address  on  Light 
Pigmentation  and  New  Growth,  in  which  the  view  is  advanced  that 

The  increase  of  cancer  within  the  last  seventy-five  years  is  perhaps  due  to  the  dimin- 
ished protection  from  light  and  increased  exposure  to  illumination.  Woolen  garments 
have  been  largely  replaced  by  cotton,  and  black  and  brown  clothes  by  those  of  a  light  color. 
Narrow  streets  and  dark  houses  are  no  longer  tolerated  and  suburban  life  has  largely 
replaced  that  of  the  city.     Artificial  light  has  become  more  actinic  in  its  character. 

He  further  concludes,  as  a  manifest  deduction  from  the  foregoing 
principles,  that  cancer  may  be  prevented  by  eflBcient  protection  of  the 
body  from  light  and  that  natural  protection,  such  as  hair  upon  the  face, 
should  be  encouraged.  The  clothing  should  be  absolutely  light-proof. 
The  ventral  surface  of  the  thorax  and  abdomen  should  be  especially 
protected.  Considering  the  almost  universal  non-protection  of  the 
upper  chest  of  many  women  at  the  present  time,  the  conclusion  of  this 
author  to  the  effect  that  "Mammary  cancer  in  women  is  usually  due  to 
insufficient  protection  of  the  breast  from  light"  may  be  quoted  as  a  word 
of  warning.  The  theory  of  Dr.  Pitchford  also  suggests  an  explanation, 
at  least  in  part,  why  the  dark-skinned  races  should  apparently  be 
so  much  less  liable  to  malignant  disease  than  the  white  races  liv- 
ing in  tropical  or  non-tropical  countries.  The  author's  complex  and 
involved  theory  which  underlies  the  practical  application  of  the  prin- 
ciples of  actinic  therapy  can  not  be  discussed  in  detail.* 

The  Synthetic-dye  Industry 

The  foregoing  discussion  is  but  an  inadequate  outline  of  an  important 
branch  of  industrial  medicine.  The  subject  is  as  yet  in  its  initial  stage 
and  few  really  substantial  contributions  have  been  made  to  the  scientific 
study  of  the  facts.  What  may  be  considered  a  classical  contribution 
to  the  problem  is  an  essay  on  the  effect  of  the  synthetic-dye  industry 
on  the  occurrence  of  tumors,  by  Dr.  S.  G.  Leuenberger  of  Zurich, 
published  in  the  Contributions  to  Clinical  Surgery  for  1912. f  The 
thoroughness  of  this  investigation  is  best  emphasized  in  the  statement 
that  the  literature  cited  includes  318  titles.  There  can  be  no  question  of 
doubt  that  further  specialized  cancer  research  in  conformity  to  this 
method  and  particularly  in  the  chemical  trades  would  yield  exception- 
ally useful  results.  Another  valuable  contribution  to  the  same  subject 
is  an  extended  discussion  of  the  so-called  Schneeberg  carcinoma  of  the 
lung,  by  Alfred  Arnstein  of  Vienna,  first  described  by  Harting  and 
Hesse  in  1878-79.  This  form  of  cancerous  growth,  as  previously  pointed 
out,  occurs  among  miners  in  the  Schneeberg  District  of  Saxony,  the 
minerals  mined  being  nickel,  cobalt  and  bismuth.  The  disease  is  con- 
sidered to  be  exceptionally  common  where,  in  damp  shafts,  there  are 
extensive  growths  of  vegetable  molds,  which  fact,  suggests  a  possi- 
ble application  in  the  present  case  of  the  theory  advanced  by  Green 

*  "Light,  Pigmentation  and  New  Growth,"  by  Wilfred  Watkins  Pitchford,  M.  D.,  F.  K.  C.  S.,  Natal,  The 
British  Medical  Journal,  August  21, 1909. 

t  "Die  unter  dem  Einfluss  der  synthetischen  Farbenindustrie  beobachtete  Geschwulstentwicklung,"  by  Dr, 
S.  G.  Leuenberger  Beitrage  zur  Kliniachen  Chirurgie,  Tubingen,  1912, 

68 


CANCER  AND  OCCUPATION 

of  Edinburgh,  elsewhere  discussed  in  this  section.  The  dissertation  by 
Arnstein  was  first  delivered  before  the  German  Pathological  Society  in 
1913,  and  printed  in  full  in  the  Clinical  Weekly  of  Vienna,  under  date  of 
May  8,  1913.* 

Finally,  a  brief  reference  requires  to  be  made  to  the  extended  dis- 
cussion of  pitch  ulceration  and  chimney-sweeps'  cancer,  etc.,  in  the 
report  of  the  Departmental  Committee  on  Industrial  Diseases  (1907), 
which  includes  a  reprint  of  the  comparative  cancer  occupation  mortality 
tables  for  England  and  Wales. 

The  Tinplate  Industry 

Quite  recently  an  investigation  has  been  made  into  the  frequency  of 
cancerous  complaints  among  persons  employed  in  the  manufacture  of 
tinplates,  and  a  brief  reference  thereto  occurs  in  a  report  on  the  "Process 
of  Tinning,"  published  by  the  Factory  Inspection  Department  of  the 
United  Kingdom  in  1912.     The  reference  reads: 

The  danger  of  long  standing  indigestion,  which  indicates  a  chronic  inflanamatory 
condition  of  the  gastro-intestinal  tract  cannot  be  overlooked;  moreover,  Victor  Bonney 
expressed  the  opinion  that  the  onset  of  carcinoma  is  constantly  preceded  by  certain  chronic 
inflammatory  changes;  and  such  evidence  as  is  obtainable' goes  to  show  that  tinhouse 
operatives  die  in  excess  from  gastro-intestinal  disease,  of  which  cancer  is  the  chief. 

The  subject  was  further  investigated  by  the  laboratories  of  the  John 
Howard  McFadden  Research  Fund  of  the  Lister  Institute  of  Preventive 
Medicine.  In  a  joint  report  on  the  results  of  an  investigation  of  the 
chronic  irritation  caused  by  fumes  and  dust  produced  in  the  process  of 
manufacturing  tinplate,  by  Messrs.  Ross  and  Cropper,  published  in  The 
Lancet  under  date  of  August  9, 1913,  it  is  stated  that 

In  the  process  of  tinning  fumes  are  given  off  which  have  a  powerful  irritating  effect  on  the 
mucous  membrane,  and  it  is  with  a  view  to  finding  out  whether  these  fumes  contain 
auxetics  and  kinetics  that  this  research  has  been  undertaken.  At  the  pitch  works  the 
pathological  lesions  are  confined  to  the  eyes  and  skin,  but  in  the  tinplate  works  the  skin 
remains  unaffected,  and  it  is  only  in  the  naso-pharyngeal  and  alimentary  passages  that  the 
irritation  is  felt. 

The  technique  and  the  details  of  the  experiments  are  briefly  de- 
scribed in  the  article,  but  more  fully  in  the  report  previously  referred 
to  on  the  problem  of  gas-works  and  pitch  industries  and  cancer, 
published  by  the  same  Fund  in  1912.  Apparently  cancerous  lesions  are 
produced  by  irritating  fumes  and  dust  in  the  tinplate  industry  in  much 
the  same  manner  and  to  much  the  same  extent,  perhaps,  as  in  the 
manufacture  of  artificial  fuel  briquettes.  The  results  of  the  investiga- 
tion were  not  entirely  conclusive,  but  in  the  meantime  it  was  considered 
advisable  to  suggest  methods  and  means  tending  to  alleviate  the  con- 
ditions at  the  tinplate-works.  It  was  therefore  proposed  by  the  authors 
that  a  substitute  or  substitutes  should  be  employed  for  the  palm  oil  used, 
such  as  mineral  oil  or  wax  or  any  suitable  substance  which  would 
be  auxetic-free,  and  which  when  mixed  under  the  industrial  condi- 
tions with  a  flux  would  continue  to  be  auxetic-free.  It  was  suggested 
that  a  suitable  substitute  be  tried  for  the  flux,  or  it  may  be  found  more  practicable  to  treat 
the  palm  oil  or  flux,  or  both,  by  re-agents  in  order  to  oxidize  the  auxetics  or  to  fix  them  by 
the  Sorenson  reaction.  Further,  it  may  be  ad\asable  to  separate  the  stages  of  the  process  of 
tinning  by  suitable  covering  of  the  various  parts  of  the  process  or  by  isolating  the  workmen. 

*"Ueber  den  sogenannten  'Schneeberger  Lungenkrebs',"  by  Dr.  Alfred  Arnstein,  Wiener  klinische  Wochew 
schrift,  Wien,  May  8,  1913. 

69 


TBE  MORTALITY  FROM  CANCER 

In  concluding  these  general  observations  on  the  occupational  incidence 
of  cancer,  the  following  brief  statement  from  "The  Pathology  of 
Growth,"  with  special  reference  to  tumors,  by  Charles  Powell  White, 
published  in  New  York,  1913,  is  of  interest: 

Chemical  substances  derived  from  the  outside  in  the  course  of  various  occupations  may 
play  a  part  in  cancer  causation.  Workers  in  soot,  tar,  parafiSn,  and  the  like  sometimes 
develop  carcinoma  of  the  skin,  which  must  apparently  be  attributed  to  their  occupation. 
In  the  case  of  chimney-sweeps  the  usual  seat  of  the  tumor  is  the  scrotum.  Tar  and  paraffin 
workers  may  develop  carcinoma  of  the  scrotum  or  of  the  arms  or  other  parts.  Arsenic 
may  give  rise  to  a  chronic  eczema  which  may  be  followed  by  carcinoma.  Workers  in 
certain  nickel  and  cobalt  mines  are  said  to  be  Uable  to  lymphocytoma  of  the  mediastinum, 
and  workers  in  dye  works  where  aniline  is  largely  used  are  liable  to  cancer  of  the  bladder. 

The  evidence  brought  together  would  seem  to  be  quite  suflScient  to 
sustain  the  conclusion  that  the  occupational  incidence  of  cancer  is  an 
important  phase  of  the  larger  problem  of  cancer  frequency  and  that 
specialized  investigations  in  this  direction  are  quite  likely  to  yield  results 
of  far-reaching  practical  importance. 

Statistics  of  Cancer  in  Relation  to  Occupation 

The  most  useful  statistical  data  regarding  the  occupational  incidence 
of  cancer  are  those  published  at  decennial  intervals  in  the  supplement 
to  the  aimual  report  of  the  Registrar- General  for  England  and  Wales. 
The  statistics  for  the  two  three-year  periods  ending  with  1892  and  1902 
have  been  brought  together  in  a  convenient  form  for  the  principal  occu- 
pations in  the  tables  appended  to  this  discussion.  The  data  for  the  three 
years  ending  with  1912  will  not  be  available  for  several  years.  Tables 
1  to  5,  inclusive,  in  Appendix  C,  give  the  number  of  persons  employed 
in  particular  groups  of  occupations,  or,  more  accurately,  the  total  num- 
ber of  years  of  life  exposed  to  risk.  The  actual  number  of  persons  con- 
sidered is  in  each  case  approximately  one-third  of  the  number  of  years  of 
life  for  the  three-year  period.  The  tables  also  give  the  total  number  of 
deaths  from  cancer  during  the  three-year  period  and  the  cancer  death 
rates  calculated  on  a  uniform  basis  of  100,000  of  population.  The  titles 
of  the  tables  in  Appendix  C,  including  the  occupation  mortality  statis- 
tics of  The  Prudential  are  given  below: 

Table  1 — Mortality  from  Cancer  in  England  and  Wales,  in  selected 

occupations,  according  to  age,  males,  1890-92. 
Table  2 — Mortality  from  Cancer  in  England  and  Wales,  in  selected 

occupations,  according  to  age,  males,  1900-02. 
Table  3 — Mortality  from  Cancer  in  England  and  Wales,  in  selected 
occupations,  males,  crude  and  standardized  death  rates,  ages  15 
and  over,  1890-92. 
Table  4 — MortaHty  from  Cancer  in  England  and  Wales,  in  selected 
occupations,  males,  crude  and  standardized  death  rates,  ages  15 
and  over,  1900-02. 
Table  5 — MortaUty  from  Cancer  in  England  and  Wales,  in  selected 
occupations,  males,  ages  15  and  over,  standardized  death  rates, 
1890-92,  compared  with  1900-02. 
Table  6 — Industrial  experience  of  The  Prudential  Insurance  Company 
of  America,  Mortality  from  Cancer,  by  occupation,  ages  35  and 
over,  males,  1907-12. 

70 


CANCER  AND  OCCUPATION 

Table  7 — Cases  of  Cancer  in  Hungary,  by  occupation,  1904. 

Table  8 — Mortality  from  Cancer  in  Hungary,  by  occupation,  1901-04. 

English  Mortality  Statistics 

On  account  of  the  limitations  of  space  the  following  b'rief  observations 
have  reference  only  to  the  mortality  from  cancer  in  selected  occupations, 
ages  15  and  over,  as  determined  by  the  crude  and  standardized  death 
rates  of  England  and  Wales  for  the  three  years  ending  with  1902  (Table  4, 
Appen  dix  C) .  Since  the  cancer  death  rate  is  in vari  ably  a  function  of  age, 
it  is  obviously  of  the  utmost  practical  importance  that  in  the  calculation  of 
cancer  mortality  rates  by  occupation  the  age  factor  should,  if  possible, 
be  taken  into  account.  Some  occupational  groups  include  a  much 
larger  proportion  of  persons  of  the  cancer  age  than  others,  as  is,  perhaps, 
best  illustrated  in  the  contrast  of  clergymen  and  persons  employed  in 
clerical  occupations  (bookkeepers,  clerks  and  copyists).  Among  clergy- 
men, according  to  the  United  States  Census  for  1900,  the  proportion 
living  at  ages  45  and  over  was  45.5  per  cent.,  compared  with  a  corre- 
sponding proportion  for  clerical  occupations  of  only  14.1  per  cent.  The 
crude  cancer  death  rates  based  upon  occupational  groups  so  funda- 
mentally at  variance  with  each  other  as  regards  age  distribution  are 
practically  certain  to  be  erroneous  and,  as  a  rule,  seriously  misleading. 
In  the  English  experience  for  1900-02,  for  illustration,  the  crude  cancer 
death  rate  for  clergymen  was  163.1  per  100,000  of  population,  as  com- 
pared with  a  rate  of  only  5^.5  for  school  teachers.  When,  however,  the 
required  standardization  is  made  for  age,  the  rates  for  the  two  groups  are 
brought  into  close  conformity  to  each  other,  the  rate  being,  for  clergymen, 
87.3,  and  for  school  teachers,  90,1.  An  equally  striking  result  is  obtained 
by  means  of  the  standardization  for  age  in  the  cancer  death  rate  of  English 
railway  engine-drivers  and  stokers,  for  which  the  crude  death  rate  of  41.9 
per  100,000  of  population  is  increased  to  a  standardized  death  rate  of  85.3. 
When  thus  standardized  for  age,  the  relative  incidence  of  cancer  in  dif- 
ferent occupations  becomes  a  reasonably  trustworthy  indication  of  the 
specific  liability  to  cancer  in  certain  employments,  although  a  further 
correction  for  the  organs  and  parts  of  the  body  affected  would  be 
necessary  to  establish  the  true  causal  relationship  existing  between 
specific  employments  and  specific  forms  of  malignant  growth. 

The  table  referred  to  (Table  4,  Appendix  C)  shows,  first,  the  recorded 
cancer  death  rate  per  100,000  of  population,  second,  the  factor  for  stand- 
ardization as  determined  by  the  variations  in  the  age  distribution  of  the 
different  groups  and,  third,  the  resulting  standardized  death  rate,  which 
alone  can  be  considered  conclusive  for  the  purpose  of  comparison.  This 
table  brings  out  the  fact  that  the  highest  standardized  cancer  death  rate 
occurred  among  chimney-sweeps,  for  which  occupation  the  rate  was  224.9 
per  100,000  exposed  to  risk.  The  rate  for  seamen  was  170.5,  and  for 
brewers,  166.6.  Relatively  high,  but  not  abnormally  excessive,  cancer 
death  rates  are  met  with  in  the  following  occupations:  fishermen,  111.9, 
tailors,  112.9,  textile-workers,  112.6,  lawyers,  111.8,  innkeepers,  108.8, 
corn-millers,  105.3,  gas-works  service,  107.1,  shoemakers,  103.2,  and 
butchers,  102.8.  Lower  cancer  death  rates  but  still  suggestive  of  special 
predisposing  conditions   are  met  with  in  the  following  occupations: 

71 


TEE  MORTALITY  FROM  CANCER 

farmers  and  graziers,  94.8,  farm  laborers,  79.7,  and  gardeners  and 
nurserymen,  85.2.  In  a  general  way  the  relative  degree  of  occu- 
pational cancer  frequency  as  disclosed  by  the  analysis  of  the  stand- 
ardized death  rates  for  1900-02  is  confirmed  by  the  previous  investi- 
gation for  the  three  years  ending  with  1892  (Table  3,  Appendix  C). 
The  wide  variations  in  occupational  conditions  suggest  the  existence 
of  causative  factors  rather  than  of  a  single  cause  as  being  responsible 
for  the  exceptional  cancer  frequency  in  certain  occupations;  but 
the  most  suggestive  result  of  this  analysis  is  the  evidence  of  an  un- 
usually high  mortality  from  malignant  disease  in  three  specific  though 
widely  difterent  employments,  namely,  chimney-sweeps,  seamen  and 
brewers.  It  is  equally  suggestive  that  relatively  high  cancer  death  rates 
should  have  been  experienced  in  more  or  less  unrelated  occupations,  i.  e., 
maltsters,  fishermen  and  persons  employed  in  the  gas-works  service. 
It  is  regrettable  that  these  statistics  should  be  so  largely  for  groups  of 
employments  rather  than  for  specific  occupations.  But  this  conclusion 
does  not  apply  to  the  three  principal  employments  with  excessive  cancer 
death  rates,  i.  e.,  chimney-sweeps,  seamen  and  brewers.  It  is  quite 
probable  that  if  certain  employments  in  the  gas-works  service  could 
have  been  separately  considered,  the  cancer  death  rate  of  such  a  selected 
group  would  have  been  found  to  be  much  higher  than  that  of  the  indus- 
try as  a  whole.  The  several  tables  in  the  Appendix  are  well-deserving 
of  extended  critical  consideration.  The  English  data  are  the  most 
trustworthy  and  conclusive  available  for  the  present  purpose,  and  the 
suggestion  may  be  made  that  as  far  as  practicable  a  corresponding 
analysis  should  be  made  of  the  occupation  mortality  data  for  the  regis- 
tration area  of  the  United  States  on  the  basis  of  the  occupation  statistics 
of  the  thirteenth  census. 

Life  Insurance  Experience  Data 

The  frequency  of  cancer  according  to  occupation  in  the  experience  of 
life  insurance  companies  has  not  been  made  the  subject  of  a  special 
study  otherwise  than  as  disclosed  by  the  medical  statistics  of  The 
Prudential  Insurance  Company  of  America,  first  exhibited  on  the  occa- 
sion of  the  Fifteenth  International  Congress  of  Hygiene  and  Demog- 
raphy. It  is  regrettable  that  this  experience  could  not  have  been 
correlated  to  the  exposed  to  risk  in  different  occupations,  but  such  an 
extension  of  the  statistical  analysis  could  have  been  made  only  at  con- 
siderable expense,  without  the  assurance  in  advance  that  the  practical 
results  would  be  commensurate  with  the  cost.  The  statistical  tabulation 
is  therefore  limited  to  the  deaths  from  cancer  by  occupations,  ages  35  and 
over,  correlated  to  the  mortality  from  all  causes  at  corresponding  periods 
of  life.  This  method  of  proportionate  mortality  analysis  is  of  consider- 
able practical  usefulness.  It  is  shown  that  the  highest  proportionate 
mortality  from  cancer,  12.32  per  cent.,  was  experienced  among  coal- 
dealers,  followed  by  teachers,  11.35  percent.,  editors  and  journalists,  9.90 
per  cent.,  laundrymen,  8.62  per  cent.,  upholsterers,  8.44  per  cent.,  gar- 
deners, 8.43  per  cent.,  brewers  and  maltsters,  5.78  per  cent.,  clergymen, 
8.00  per  cent.,  engineers  (not  specified),  7.90  per  cent.,  sawyers,  7.65  per 
cent.,  clothing-workers  (tailors),  7.49  per  cent.,  plasterers,  7.10  per  cent. 

72 


CANCER  AND  OCCUPATION 

Limitations  of  Occupational  Mortality  Statistics 
These  statistics  are  not  conclusive  and  should  be  accepted  with 
caution.  They  show,  for  illustration,  that  tanners,  who  in  the  English 
experience  had  a  low  mortality,  had  in  the  Prudential  experience  a 
comparative  figure  of  6.02  per  cent.,  against  5.78  per  cent,  for  brewers  and 
maltsters.  How  far  the  element  of  medical  selection  affects  these  data 
is  rather  doubtful.  The  medical  examination  required  for  Industrial 
insurance  purposes  is  generally  not  very  thorough,  but  it  would  be  apt 
to  be  more  thorough  in  the  case  of  brewers  and  maltsters,  as  well  as  in  the 
case  of  persons  otherwise  connected  with  the  ale,  wine  and  liquor  traffic, 
than  of  those  not  so  employed.  The  statistical  tables  are,  therefore,  pre- 
sented with  some  reluctance,  and  they  are  to  be  rather  considered  as  a 
preUminary  contribution  towards  a  more  scientific  and  thoroughly 
representative  inquiry  into  the  facts.*  Thus  far  no  cancer  occupation 
mortality  data  derived  from  life  insurance  experience  have  concisely 
differentiated  the  organs  and  parts  of  the  body  affected.  As  brought 
out  by  the  previous  discussion,  the  possible  local  irritant  responsible  for 
cancer  growth  must  necessarily  be  limited  to  the  particular  parts  of  the 
body  more  exposed  than  others,  on  account  of  special  occupational  activi- 
ties. The  frequency  of  cancer  of  the  scrotum  in  chimney-sweeps  and  of 
cancer  of  the  urinary  organs  in  persons  employed  in  the  manufacture 
of  aniline  dyes  suggest  the  practical  value  of  a  more  specialized  statisti- 
cal investigation  in  this  field. 

Iiritability  and  Cancer  Causation 
The  foregoing  brief  discussion  of  an  important  phase  of  the  cancer 
problem  emphasizes  the  urgency  of  more  extended  occupational  studies 
than  have  thus  far  been  made.  Cumulative  evidence  would  tend  to 
establish  the  truth  or  the  falsity  of  prevaiUng  opinion  and,  in  any  event, 
eliminate  much  misleading  information.  The  fundamental  concept  of 
irritability  as  the  direct  or  contributing  cause  of  cancerous  growth  is 
apparently  well  sustained  by  occupational  studies  of  the  cancer  problem. f 
All  disease,  it  is  held  by  the  foremost  author  on  irritability,  or  the  effect 
of  stimuli  in  living  substances,  "consists  of  the  influence  of  stimuli  upon 
these  physiological  processes."  "Every  disease,"  he  maintains,  "repre- 
sents only  a  disturbance  of  the  physiological  processes  of  cell  life  of  the 
organism  and  the  harmony  in  their  combined  workings."  Believing 
that  the  available  evidence  regarding  cancer  warrants  the  conclusion 
that  malignant  disease  is  not  the  result  of  a  single  cause,  I  can  not  do 

*Iii  this  connection  the  following  sources  of  information  on  cancer  occupation  mortality  statistics  should  be 
consulted:  Ueber  den  Einfluss  von  Beruf  und  Lebensstellung  auf  die  Todesursachenin  Halle,  a.  S.,  1901-09. 
Recueil  de  Statistique  Municipale  de  la  ville  de  Paris,  Dr.  Jacques  Bertillon,  IQl^.  Ungarische  Statistische 
Mitteilungen;  Statistik  der  Krebskranken  in  den  Landern  der  L'ngarischen  Heiligen  Krone,  1908.  Bericht 
ueber  die  vom  Komite  fur  Krebsforschung  am  15  Oktober,  1900,  erhobene  Sammelforschung,  Jena,  1902,  Das 
Vorkommen  des  Krebses  in  Baden,  Dr.  R.  Werner.  The  morbidity  and  mortality  experience  of  the  Leip- 
zig Communal  Sick  Fund,  Berlin,  1910.  Mortality  Statistics,  1908-09,  Division  of  Vital  Statistics,  Bureau 
of  the  United  States  Census. 

tThe  technical  aspects  of  the  problem  of  causation  or  conditioning  circumstances  from  the  pathological 
point  of  view  have  been  discussed  by  Gustav  Heim  in  Virchow's  Archiv.,  Vol.  ccxvi,  Berlin,  1914.  The  philo- 
sophical aspects  of  causation  are  fully  discussed  by  Stanley  Jevonsin  his  "Principles  of  Science"  (Vol.  i,  p.  ioi, 
et  seg.),  who  observes  that  "the  work  of  science  consists  in  ascertaining  the  combination  in  which  phenomena 
present  themselves,"  which  is  precisely  the  object  and  proper  use  of  the  statistical  method  in  cancer  research. 
See  also  in  this  connection  Pearson's  "Grammar  of  Science"  ('2d  edit.,  p.  113,  et  seq.),  and  John  Stuart  Mill's 
"Logic"  (New  York,  1891,  8th  edit.,  p.  311),  on  'Tlurality  of  Causes,"  who  observes,  inter  alia,  "It  is  not 
true  that  the  same  phenomenon  is  always  produced  by  the  same  cause." 

73 


THE  MORTALITY  FROM  CANCER 

better  than  conclude  by  quoting  the  following  most  carefully  consid- 
ered remarks  of  Dr.  Max  Verworn,  the  author  of  a  standard  work 
on  "Irritability": 

Another  point  concerning  the  application  of  the  conception  of  cause  seems  to  me, 
however,  to  be  of  much  more  importance,  namely,  that  a  single  cause  is  held  responsible 
for  the  taking  place  of  a  process.  One  endeavors  to  explain  a  process  in  general  by  seeking 
for  its  "cause."  The  cause  being  found,  the  process  is  considered  fully  accounted  for. 
This  idea  is  not  one  widely  spread  in  everyday  Hfe,  but  is  found  frequently  in  natural 
science,  especially  in  biology,  although  here,  it  should  be  known,  the  processes  are  decidedly 
more  complicated.  The  search  for  the  "cause"  of  development,  for  the  "cause"  of  hered- 
ity, for  the  "cause"  of  death,  for  the  "cause"  of  the  respiration,  for  the  "cause"  of  the 
heart  beat,  for  the  "cause"  of  sleep,  for  the  "cause"  of  disease,  etc.,  was  for  a  long  time  and 
frequently  even  to-day  a  characteristic  of  biological  investigation.  As  if  such  a  compli- 
cated process  as  development,  death  or  disease  could  be  explained  by  a  single  factor!  In 
reality,  one  has  obtained  very  little  as  a  result  of  the  analysis  of  a  process  by  discovering  its 
cause;  and,  in  addition,  the  false  impression  arises  that  through  the  finding  of  this  one 
factor  the  process  has  been  definitely  explained.  It  has  been  generally  recognized  in  the 
natural  sciences  in  recent  times  that  no  process  in  the  world  is  dependent  upon  one  single 
factor  and  attempts  have  been  made  to  give  this  fact  more  consideration. 

This  conclusion  applies  with  special  force  to  the  cancer  problem  and 
provides  the  best  possible  answer  to  the  constantly  recurring  question 
as  to  the  cause  of  cancer  and  its  direct  relation  to  the  larger  problem  of 
prevention,  treatment  and  control.* 

Foreign  Cancer  Census  Investigations 

The  scientific  study  of  the  occupational  incidence  of  cancer  has  been 
attempted  with  more  or  less  success  by  means  of  special  cancer  censuses, 
the  results  of  which,  however,  as  a  rule,  have  not  been  correlated  to  the 
living  population  with  a  due  regard  to  age  and  sex.  These  investiga- 
tions can  not  be  fully  discussed  here,  but  they  are  referred  to  briefly  as 
an  indication  of  the  direction  of  research  work,  which  is  likely  to  prove 
of  considerable  practical  value. 

The  German  cancer  census  of  1902t  presents  the  collected  cancer  cases, 
by  occupations,  according  to  sex,  for  the  empire  as  a  whole,  and  for  the 
large  cities  separately,  and  also  with  reference  to  organs  or  parts  of  the 
body  affected.  The  investigation  considered  only  those  suffering  from 
the  disease  who  were  actively  employed,  or  employable,  or,  in  other 
words,  persons  in  the  advanced  stage  of  the  disease  were  apparently  ex- 
cluded. The  table  below  gives  the  details  for  certain  broad  divisions  of 
occupations,  and  while  not  conclusive,  the  facts  are  certainly  suggestive. 
Cancer  in  Germany,  by  Organs  and  Parts,  according  to  Occupation,  Males 

All  Textile  Metal        Wood-     Trans- 

Occupa-      Agri-      Manufac-  Common  Work-      working    porta- 

Organ  or  Part  tions        culture  ture        Laborers     Retired  ers         Industry      tion 

Bones 25  21  19  21  20  30  41  23 

Skin 150  250  99  140  163  90  110  112 

Respiratory  organs....  20  7  19  16  24  30  21  14 

Digestive  organs 703  642  783  718  703  750  685  748 

Urinary  organs 15  8  ..  10  45  30  13  6 

Glands 59  54  53  56  28  35  96  70 

Breast 4  1  ..  2  4  15  13  9 

Generative  organs 24  17  27  37  13  20  21  19 

Total 1,000       1,000       1,000       1,000       1,000       1,000       1,000       1,000 

*See  discussion  of  Cancer  in  Selected  Occupations,  Bulletin  of  American  Academy  of  Medicine,  1914. 
tBericht  ueber  die  vom  Komite  fur  Krebsforschung  am  15  Oktober,  1900,  erhobene  Sammelforschung, 
Jena,  1902. 

74 


CANCER  AND  OCCUPATION 

Cancer  in  Germany,  by  Organs  and  Parts,  according  to  Occupation,  Females 

All  Textile  Restau-  Do- 

Occupa-      Agri-      Manufac-   Common  rant,  etc.,     Laun-      mestic 

Organ  or  Part  tions        culture  ture         Laborers     Retired      Keepers      dresses     Service 

Bones 11  18  10  11  10  ..  8  20 

Skin 73  151  52  95  88  ..  116  81 

Respiratory  organs ....  3  ..  5  4 

Digestive  organs 306  338  235  374  311  244  349  323 

Urinary  organs 6  4  10  4  4  ..  ..  10 

Glands 55  73  26  54  38  122  16  61 

Breast 243  208  287  154  374  220  240  111 

Generative  organs 303  208  375  304  175  414  271  394 

Total 1,000       1,000       1,000       1,000       1,000       1,000       1,000       1,000 

As  an  illustration  of  the  value  of  this  method  of  statistical  analysis  the 
excessive  relative  incidence  of  cancer  of  the  skin  in  agriculture  may  be  re- 
ferred to,  the  proportion  among  males  having  been  25  per  cent,  of  all 
cancers,  against  only  9  per  cent,  for  workers  in  the  metallic  industries 
and  11  per  cent,  for  workers  in  the  wood- working  industries.  The  same 
pronounced  differences  regarding  the  incidence  of  cancer  of  the  skin 
appear  among  female  workers,  the  proportion  for  those  in  agriculture 
having  been  15.1  per  cent.,  against  only  8.1  per  cent,  for  domestic 
service.  Tables  of  this  kind,  however,  require  to  be  standardized  for 
variation  in  age  distribution,  which,  unfortunately,  is  not  possible  on 
the  basis  of  the  data  as  derived  from  the  German  cancer  census.* 

The  occupational  incidence  of  cancer  was  also  reported  upon  in  the 
Hungarian  cancer  census,  published  in  1908. f  This  investigation  is 
limited  to  males  in  specified  industries  correlated  to  the  population  as 
determined  by  the  general  census.  The  data  are  subjected  to  a  check 
through  a  subsequent  analysis  of  the  cancer  mortality  by  occupations  for 
the  period  1901-04.  |  The  highest  relative  cancer  figure  was  for  day 
laborers,  13.66  cases  per  10,000  employed,  followed  by  butchers,  with 
11.57,  and  independent  traders,  with  9.27.  In  a  general  way,  the  data 
ascertained  by  the  cancer  census  were  confirmed  by  the  mortality  analysis, 
but  there  are  important  variations,  due,  no  doubt,  largely  to  the  varying 
age  distribution  of  the  different  occupational  groups,  which  unfortunately 
could  not  be  taken  into  account.  As  an  illustration  of  the  relative  inci- 
dence of  cancer  in  the  more  important  groups  of  occupations,  it  may 
be  pointed  out  that  while  day  laborers  experienced  a  cancer  morbidity 
rate  of  13.66  per  10,000,  the  corresponding  rate  for  the  mining  in- 
dustry was  only  3.37,  and  for  agriculture,  1.74.  As  brought  out  by 
the  mortality  analysis,  day  laborers  experienced  a  rate  of  8.66  per  10,000, 
the  mining  industry,  4.81,  and  agriculture,  4.59.  These  differences 
are  so  pronounced  that  they  warrant  the  conclusion  that  really  use- 
ful and  conclusive  investigations  into  the  occupation  incidence  of 
cancer  require  to  be  made  with  a  due  regard  to  the  age  distribution  of  the 

*The  experience  data  of  the  Leipzig  Communal  Sick  Fund  are  valuable  tor  general  purposes,  but  hardly 
conclusive  regarding  the  comparative  incidence  of  cancer  in  different  occupations.  For  all  compulsorily  in- 
sured males  the  cancer  death  rate  per  100,000  of  population  at  ages  15-24  was  1.1 ;  at  ages  25-34,  3.4;  at  ages 
35-44,  23.1;  at  ages  45-54,  100.1;  at  ages  55-64,  215.7;  at  ages  65-74,  375.5;  and  at  all  ages,  24.4.  For  those 
insured  voluntarily  the  rates  throughout  were  much  higher,  and  for  all  ages  combined  the  mortality  was  196.6. 
For  females  the  numbers  exposed  to  risk  are  much  less  and  the  data  are  obviously  inconclusive. 

fStatistik  der  Krebskranken  in  den  Landern  der  Ungarischen  Heiligen  Krone,  Budapest,  1908. 

tTables  7  and  8,  Appendix  C. 

75 


THE  MORTALITY  FROM  CANCER 

persons  employed  and  the  organs  and  parts  of  the  body  affected  by  can- 
cerous growths.  The  incidence  of  cancer  among  women,  according  to 
occupation,  is  also  briefly  considered  and  the  facts,  presented  in  detail, 
are  deserving  of  more  attention  than  they  have  received  in  the  past. 

A  very  important  contribution  to  the  statistical  study  of  cancer,  with 
particular  reference  to  occupation,  social  condition,  etc.,  was  published 
in  1904  in  the  "Journal  of  the  German  Society  for  Cancer  Research." 
This  investigation  was  made  by  a  commission  of  the  Medical  Society  of 
Stuttgart.  The  authors  of  the  report  were  Drs.  Weinberg  and  Gastpar. 
Investigations  of  this  kind  emphasize  the  extremely  complex  nature  of 
the  cancer  problem  statistically  considered,  and  the  conclusion  that  the 
intricacy  of  causal  connection  of  the  phenomena  under  observation  in- 
creases in  proportion  to  the  number  of  separate  circumstances  or  condi- 
tions subjected  to  critical  analysis.  Another  important  occupational 
study,  with  a  due  regard  to  organs  and  parts  of  the  body  affected,  occurs 
in  the  Swedish  cancer  census  of  1905-06,  published  in  the  "Journal  of 
the  German  Society  for  Cancer  Research"  for  1909. 

Karl  Kolb,  Secretary  of  the  Cancer  Society  of  Bavaria,  contributed  an 
instructive  discussion  of  the  relation  of  occupation  to  cancer,  reduced  to 
a  uniform  basis  of  a  normal  population  with  a  due  regard  to  age,  to  the 
"Journal  of  the  German  Society  for  Cancer  Research"  of  1910.  This 
investigation  includes  some  interesting  data  regarding  the  cancer  inci- 
dence among  nuns  and  nurses,  but  unfortunately  the  statistics  were  not 
reduced  to  rates  on  the  basis  of  the  living  population.  Many  of  the  tables 
in  this  and  other  investigations  would  have  been  materially  increased  in 
value,  if  the  data  had  been  given  by  divisional  periods  of  life,  and  in  all 
cases  by  the  organs  or  parts  of  the  body  affected. 

Requirement  for  Scientific  Statistical  Research 
The  material  brought  together  by  these  and  other  investigators  has  not 
received  the  required  amount  of  qualified  and  strictly  impartial  con- 
sideration. It  would  seem  useless  to  encourage  statistical  research  of 
this  kind  unless  there  is  more  conformity  to  practical  and  standardized 
methods  of  inquiry.  It  would  also  seem  much  better  to  select  a  carefully 
chosen  group  of  specific  occupations  apparently  subject  to  an  excessive 
incidence  of  cancer,  or  more  or  less  relatively  free  therefrom,  and  to  rigor- 
ously examine  the  details  of  the  experience,  with  a  due  regard  to  the 
age  distribution  of  the  persons  considered  and  the  organs  and  parts  of 
the  body  affected.  If  such  an  analysis  were  made  of  the  cancer  mor- 
tality of  workers  in  agriculture,  gardeners,  florists,  brewers,  etc.,  known 
to  be  subject  to  a  high  cancer  mortality,  and  tanners,  miners,  etc., 
known  to  be  subject  to  a  low  or  at  least  normal  mortality,  the  results 
would  be  unquestionably  of  much  value  to  the  medical  and  surgical 
profession,  as  well  as  to  those  employed  in  the  particular  occupations 
considered.  The  present  study  must  be  considered  inconclusive  from 
this  point  of  view,  except  in  so  far  as  it  has  been  shown  that  there  are 
unquestionably  certain  industries  which  make  the  persons  employed 
therein  distinctly  liable  to  cancerous  growths  in  varying  forms,  and 
that  res'ults  of  far-reaching  value  to  the  cancer  problem  as  a  whole  may 
be  derived  from  a  more  scientific  study  of  the  occupational  incidence  of 
cancer  than  has  thus  far  been  made. 

76 


CHAPTER  V 
CANCER  AS  A  PROBLEM   IN  LIFE  INSURANCE  MEDICINE 

Cancer  in  the  Literature  of  Life  Insurance  Medicine — Early  Life  Insurance  Experience 
Data — Discussion  of  Scottish  Widows'  Fund  Experience — Observations  Regarding 
Cancer  Increase — Experience  of  American  Life  Insurance  Companies — German  and 
Austrian  Insurance  Experience — Medico- Actuarial  Investigation — Family  Historj' — 
Effect  of  Build  and  Conjugal  Condition — Cancer  of  Breast  and  Generative  Organs 
among  Single  and  Married  Women — Experience  of  The  Prudential  Insurance 
Company  of  America — Cancer  as  a  Life  Insurance  Problem. 

Cancer  in  its  relation  to  life  insurance  presents  itself  in  a  threefold 
aspect:  first,  as  a  problem  in  medical  selection  or  insurance  medicine, 
second,  as  an  element  in  insurance  experience,  and  third,  as  a  question  of 
state  medicine,  with  a  special  regard  to  the  educational  value  of  cancer 
statistics  and  the  feasibility  of  cancer  control.  The  importance  of  the 
problem  is  set  forth  in  the  statement  that  the  approximate  mortality 
from  cancer  in  the  Continental  United  States  for  1915  is  over  80,000. 
Considered  by  organs  and  parts  of  the  body  affected,  the  estimated* 
mortality  for  1915  is  as  follows: 

Estimated   Mortality  from   Cancer,   by   Organs   and   Parts,   in 
Continental  United  States,   1915 

Organ  or  Part  Deaths  Per  Cent. 

Buccal  cavity 3,152  3.9 

Stomach  and  liver 31,672  39.6 

Peritoneum,  intestines,  rectum.  .  .  .  10,616  13.3 

Female  generative  organs 12,344  15.4 

Breast 7,360  9.2 

Skin 2,760  3.5 

Other  or  not  specified  organs 12,096  15.1 

80,000  100.0 

For  the  year  1910  the  average  age  at  death  from  cancer  and  other  malig- 
nant tumors  combined  was  59.2  years  for  the  registration  area  of  the 
United  States.  For  males  the  average  age  at  death  was  60.4  years  and 
for  females,  58.4  years.  The  average  age  at  death  in  cancer  of  the  buc- 
cal cavity  was  63.1  years;  in  cancer  of  the  stomach  and  liver,  61.2  years; 
in  cancer  of  the  peritoneum,  intestines  and  rectum,  59.2  years;  in  can- 
cer of  the  female  generative  organs,  53.8  years;  in  cancer  of  the  breast, 
58.3  years;  in  cancer  of  the  skin,  68.0  years;  and  in  cancer  of  other  or- 
gans and  parts  of  the  body  not  specified,  56.9  years. 

Cancer  is  essentially  a  disease  of  advanced  adult  life.  Of  the  mor- 
tality from  all  causes  in  the  registration  area,  1908-12,  at  ages  45  and 
over,  the  proportion  of  deaths  from  cancer  was  9.3  per  cent.,  or  7.1  per 
cent,  for  males  and  11.9  per  cent,  for  females.  During  the  period 
1901-11  in  the  states  included  in  the  registration  area  in  1900  (Table  60, 
Appendix  F,  Part  1)  the  cancer  death  rate  for  all  ages  increased  from  65.8 

*Estimated  on  the  basis  of  the  actual  distribution  of  the  mortaJity  by  organs  and  parts  in  the  United 
States  registration  area  in  1913. 

77 


THE  MORTALITY  FROM  CANCER 

per  100,000  of  population  in  1901  to  83.9  in  1911.  The  cancer  death  rate 
of  males  increased  from  48.7  to  64.2  per  100,000  of  population,  or  31.8 
per  cent.,  and  the  cancer  death  rate  of  females  increased  from  83.0  to 
104.0,  or  25.3  per  cent.  For  males  the  increase  in  cancer  during 
this  period  was  21  per  cent,  at  ages  45-54;  at  ages  55-64  it  was  39 
per  cent. ;  at  ages  65-74  it  was  40  per  cent. ;  and  at  ages  75  and  over  it  was 
40  per  cent.  For  females  the  increase  in  the  cancer  death  rate  at  ages 
45-54  was  11  per  cent.;  at  ages  55-64  it  was  27  per  cent.;  at  ages  65-74 
it  was  32  per  cent. ;  and  at  ages  75  and  over  it  was  44  per  cent. 

Cancer  and  Insurance  Medicine 

As  a  problem  in  insurance  medicine  cancer  presents  unusual  difficulties 
to  both  the  examining  physician  and  the  medical  director.  The  litera- 
ture of  the  subject  extends  over  more  than  half  a  century,  since  prac- 
tically every  authority  on  insurance  medicine  has  given  the  subject  at 
least  incidental  consideration.  Most  of  the  earlier  writers,  beginning 
with  Brinton  in  1856,  emphasize  the  assumed  hereditary  character  of 
cancerous  affections,  but  as  early  as  1857  Ward  called  attention  to  the 
personal  aspects  of  the  disease,  as  made  evident  m  "sallowness  or  pallor 
of  the  face,  the  general  clayey  hue  of  the  skin,  and  peculiar  sadness  of 
expression."  Also,  "the  anaemic,  chlorotic  aspect  of  females  suffering 
from  uterine  derangement."  Allen,  who  was  one  of  the  first  American 
writers  on  insurance  medicine,  in  his  "Medical  Examinations  for  Life 
Insurance,"  published  in  1866,  referred  briefly  to  the  subject,  under  the 
general  title  of  tumors,  giving  a  few  directions  of  value  in  medical  exam- 
inations and  advising  unconditional  rejection  even  in  the  case  of  sus- 
picion of  a  liability  to  non-malignant  tumors,  as  involving  danger  by 
their  anatomical  position  or  as  possibly  requiring  a  severe  surgical 
operation. 

Observations  by  Sieveking  and  Moinet 

Sieveking  in  1874  advanced  the  view  that  while  authorities  differed 
as  to  the  frequency  with  which  cancer  was  hereditary,  "all  are  agreed 
as  to  the  general  fact."  He  quotes  Velpeau  as  being  of  the  opinion  that 
one  in  three  cases  of  cancer  showed  a  hereditary  taint.  Sir  James  Paget's 
investigations  as  yielding  one  in  four,  Sibley's  statistics  of  the  Middlesex 
Hospital  as  showing  a  proportion  of  one  in  twelve;  but  regardless  of  the 
wide  variation  he  accepted  the  view  of  the  "undoubted  hereditariness  of 
cancer." 

Moinet  in  1876  in  his  "Guide  to  Medical  Examination  for  Life  Insur- 
ance," also  referred  to  the  investigations  of  Paget  as  indicating  a  ten- 
dency of  cancerous  disease  "to  pass  by  inheritance  from  parent  to  off- 
spring and  to  occur  (probably  by  inheritance  of  common  properties)  in 
many  members  of  the  same  family  and  generation." 

Observations  by  Greene,  Hall  and  Ramsey 

These  views  have  continued  to  prevail  among  writers  on  cancer  as  a 
problem  in  medical  selection  for  insurance,  and  passing  over  a  number 
of  early  authors  whose  conclusions  are  practically  identical,  a  first 
reference  requires  to  be  made  to  the  standard  treatise  by  Charles  Lyman 
Greene  on  "Medical  Examination  for  Life  Insurance,"  published  in  1905, 
in  which  occurs  the  statement  that  "The  hereditary  nature  of  cancer  is 

78 


CANCER  AND  LIFE  INSURANCE 

a  subject  of  dispute,  but  the  weight  of  evidence  is  strongly  in  favor  of  a 
well-marked  hereditary  influence."  Haviland  Hall  in  1906  in  the 
third  edition  of  his  "Medical  Examination  for  Life  Assurance,"  writes 
that  "Cancer  comes  next  to  consumption  in  regard  to  frequency  of 
hereditary  transmission."  Ramsey  in  1908  in  his  "Practical  Life 
Insurance  Examinations,"  accepts  the  hereditary  theory  of  cancer  oc- 
currence, and  Brockbank  in  1908  in  his  work  on  "Life  Insurance  and 
General  Practice,"  concludes  that  "Females  show  a  greater  tendency 
to  inherit  whatever  is  the  condition  which  leads  to  cancer  than  males 
do,  and  they  also  die  from  it  at  a  younger  age  than  their  brothers  would." 

London  Equitable  Experience,  1800-1821 

Few  of  the  writers  on  insurance  medicine  have  given  useful  advice  on 
methods  of  diagnosis  to  disclose  either  an  existing  cancerous  condition 
or  a  well-pronounced  tendency  to  the  disease.  The  over-emphasis 
placed  on  the  assumed  hereditary  theory  has  no  doubt  done  much  harm, 
in  that  it  has  prevented  a  due  consideration  of  the  non-hereditary 
aspects  of  the  disease  when  considered  from  a  life  insurance  point  of  view. 
It  is  also  quite  probable  that  most  of  the  writers  have  taken  for  granted 
a  general  disposition  on  the  part  of  the  examining  physician  to  accept 
and  act  upon  the  prevailing  theories  in  medical  diagnosis,  direct  and 
differential,  which,  it  is  needless  to  say,  has  made  considerable  progress 
during  recent  years.  This  conclusion  applies  not  only  to  cancers  in 
general,  but  particularly  to  cancer  of  the  stomach  and  in  the  case  of 
women,  to  cancer  of  the  breast. 

Cancer,  in  the  experience  of  life  insurance  companies,  has  been  the 
subject  of  occasional  consideration,  but  not  of  very  extended  and 
thoroughly  specialized  inquiry.  A  review  of  the  available  statistics, 
extending  over  more  than  a  century,  tends  to  confirm  the  conclusion 
that  during  the  long  intervening  period  of  time  the  mortality  from  can- 
cer has  gradually  and  persistently  increased  from  a  comparatively  low 
rate  of  occurrence  to  a  frequency  that  may  appropriately  be  considered 
a  menace  to  mankind.  The  earliest  experience  data  are  those  of  the 
London  Equitable  Society  for  the  period  1800-21,  in  which  out  of 
1,930  deaths  from  all  causes,  only  25,  or  1.3  per  cent.,  were  from  cancer; 
eliminating  deaths  under  age  40,  it  appears  that  out  of  1,720  deaths 
from  all  causes,  24,  or  1.4  per  cent.,  were  ascribed  to  cancer. 

Scottish  Widows'  Fund  Experience,  1815-1852 

The  Scottish  Widows'  Fund  published  its  experience  for  the  period 
1815-45,  by  divisional  periods  of  life,  but  not  by  sex,  including  642  deaths 
from  all  causes,  and  of  this  number  only  6,  or  0.9  per  cent.,  were  from 
cancer, but  in  addition  thereto,5,or  0.8  per  cent., were  ascribed  to  tumors. 
The  experience  of  the  same  society  for  1846-52  was  published  in 
the  form  of  a  treatise  on  medical  statistics  of  life  assurance,  by  James 
Begbie,  in  the  year  1853.  This  experience  includes  690  deaths  from  all 
causes,  of  which  only  5,  or  0.7  per  cent.,  were  from  cancer,  but  7,  or  1.0 
per  cent,  of  the  mortality,  were  ascribed  to  tumors.  It  is  practically 
certain  that  in  the  experience  of  this  company  most,  if  not  all,  of  the 
deaths  from  tumors  were  due  to  malignant  growths,  as  made  clear  by  the 
following  remarks  of  the  author: 

79 


THE  MORTALITY  FROM  CANCER 

Two  of  the  cases  of  cancer  occurred  in  the  female  breast;  one  in  the  testis  of  a  young  man 
of  26;  and  the  remaining  two  in  the  face,  the  subjects  being  males  of  the  ages  of  56  and  63. 
Under  the  name  of  tumor,  seven  deaths  are  recorded.  Two  of  these  occurred  in  elderly 
gentlemen  of  74  and  75 ;  and  the  disease  in  both  appeared  to  be  of  malignant  growth.  Two 
occurred  in  men  of  41  and  57;  the  disease  affected  the  abdomen,  and  was  considered  of 
encephaloid  character.  In  another,  the  fatal  disease  appeared  on  the  right  side  subse- 
quent to  amputation  for  disease  of  the  knee-joint.  The  sixth  death  arose  from  malignant 
tumor  of  the  foot;  and  the  seventh  from  that  of  the  jaw. 

If,  therefore,  the  deaths  from  cancer  and  tumors  are  combined,  it 
appears  that  there  were  12  deaths  from  malignant  disease  out  of  a  total 
mortality  of  690,  or  1.7  per  cent.,  which  compares  with  a  combined 
mortality  from  cancers  and  tumors  of  11  deaths  during  the  period  1815-45 
out  of  a  total  mortality  of  642,  or  also  1.7  per  cent. 

Scottish  Amicable  Experience,  1826-1860 

The  Scottish  Amicable  experience  for  1826-60  was  published  in  1861, 
giving  details  of  the  mortality  according  to  non-hazardous,  hazardous  and 
West  Indian  risk  exposure,  by  ages  and  divisional  periods  of  life.  The 
non-hazardous  risks  were  the  most  numerous,  including  632  deaths  of 
males,  of  which  11,  or  1.7  per  cent.,  were  deaths  from  cancer,  and  63 
deaths  of  females,  of  which  3,  or  5.3  percent.,  were  from  malignant  disease. 
In  addition  thereto,  among  the  males  there  were  2  deaths  from  tumors, 
equivalent  to  0.3  per  cent.  In  the  hazardous  class  of  risks  there  were  47 
deaths  from  all  causes,  with  no  deaths  from  cancer,  and  in  the  West 
Indian  group  of  risks  there  were  31  deaths  from  all  causes,  also  with  no 
deaths  from  cancer. 

Standard  Life  Company  Experience,  1825-1855 

The  Standard  Life  Assurance  Company  experience  for  1825-45  in- 
cludes 193  deaths  of  males,  of  which  none  were  ascribed  to  cancers 
or  tumors,  but  out  of  23  deaths  of  females,  1,  or  4.3  per  cent.,  was 
attributed  to  cancer.  The  experience  of  the  same  company  for  1845-50 
included  293  deaths  of  males  and  females  and, of  this  number  3,  or  1.0 
per  cent.,  were  ascribed  to  malignant  disease.  The  same  company  also 
published  its  experience  for  1850-55,  including  424  deaths  from  all 
causes,  of  which  5,  or  1.2  per  cent.,  were  attributed  to  malignant 
disease.  In  the  report  on  the  company's  experience,  published  in  1858, 
the  subject  of  cancer  is  referred  to  at  some  length,  it  being  stated 
that  the  term  includes  cancer,  scirrhus,  fungus  hsematodes  and  some 
other  malignant  affections  of  less  frequent  occurrence.  The  report 
points  out  that 

Diseases  of  this  denomination  have  not  hitherto  received  from  Assurance  Companies 
the  attention  which  they  appear  to  me  to  deserve.  They  are  well  known  to  be  most 
frequent  about  middle  life,  and  between  that  and  commencing  old  age.  They  occur, 
therefore,  chiefly  at  a  period  immediately  subsequent  to  that  at  which  many  assurances 
are  effected.  Of  717  deaths  during  the  last  ten  years  among  those  assured  in  the  Standard 
Assurance  Company,  no  fewer  than  426  happened  among  persons  assured  for  the  first 
time  after  the  age  of  40.  Death  from  malignant  disease  is  also  frequent — more  so  than 
may  appear  either  from  the  statistical  returns  of  Assurance  Companies,  or  from  the 
mortality  tables  of  the  country  at  large.  During  the  last  quinquennium  of  the  Standard 
Assurance  Company,  only  five  deaths  are  referred  to  maHgnant  diseases,  and  three  in  the 
previous  quinquennium — that  is,  a  trifle  above  one  per  cent,  of  the  total  deaths  in  ten  years. 
But  the  majority  of  deaths  referred  in  the  Table  to  disease  of  the  stomach  and  disease  of  the 
uterus,  24  in  number,  have  also  undoubtedly  arisen  from  malignant  affections  of  these 
organs.     Another  addition  may  be  confidently  made  of  a  fair  proportion  of  33  deaths 

80 


CANCER  AND  LIFE  INSURANCE 

referred  to  disease  of  the  liver.  And  I  apprehend  that  a  further  addition  must  be  made  of 
a  smaller,  yet  no  insignificant,  proportion  of  46  deaths  ascribed  to  disease  in  the  bladder, 
disease  in  the  kidneys,  dropsy,  and  obstruction  of  the  bowels;  since  it  is  no  uncommon 
thing  for  structural  changes  of  a  malignant  character  to  be  at  the  foundation  of  these 
disorders.  Assuming  one-half  of  the  first  denomination,  a  fourth  of  the  second,  and  a 
tenth  of  the  third,  to  have  been  owing  fundamentally  to  mahgnant  degenerations  of  some 
internal  organ,  we  will  be  under  the  truth,  I  apprehend,  in  thus  raising  the  deaths  from 
malignant  diseases  to  eight  per  cent,  of  the  mortality  among  persons  assured  after  the  age 
of  forty. 

It  will  not  be  easy  to  arrive  at  a  more  precise  result  than  this  from  the  experience  of  an 
Assurance  Company.  Greater  accuracy  may  be  effected  by  and  by  in  the  certificates  of 
the  cause  of  death,  as  medical  men  become  better  acquainted  with  their  object,  and  the 
importance  of  accuracy  in  them.  Accordingly,  it  is  not  unworthy  of  note,  that  the 
frequency  with  which  malignant  disease  is  mentioned  in  the  certificates  of  death  received 
by  the  Standard  Assurance  Company  has  increased  since  this  paper  was  read  to  the 
Medico-Chirurgical  Society  two  years  ago.  For  of  192  deaths  between  15th  November, 
1855,  and  loth  November,  1857,  six  are  confidently  referred  to  malignant  diseases  of  the 
breast,  leg,  or  stomach.  But,  in  point  of  fact,  there  is  an  insuperable  obstacle  in  the  way 
of  more  definite  information;  one  not  to  be  removed  by  any  amount  of  zeal  or  conscien- 
tiousness on  the  part  of  the  certifying  physicians.  The  proof  of  a  disease  being  malignant 
in  its  nature  can  seldom  be  obtained,  if  it  affect  an  internal  organ,  without  an  inspec- 
tion of  the  body  after  death;  and  I  regret  to  say  that  this  is  a  rare  help  to  Assurance 
statistics,  at  all  events  in  the  experience  of  the  Standard  Company.  For  the  same 
reason  it  is  vain  to  turn  for  better  information  to  the  mortality  registers  of  the  country 
at  large.  More  precise  information  may  perhaps  be  expected  from  the  records  of  a 
great  hospital,  where,  as  in  the  Royal  Infirmary  of  Edinburgh,  pathological  examina- 
tions are  numerous,  carefully  made,  and  faithfully  recorded.  But  various  reasons  may  be 
stated  against  accepting  results  thus  obtained  as  representing  the  incidents  of  an  Assurance 
Company.  Dr.  William  T.  Gairdner  has  had  the  goodness  to  search  for  me  the  Patho- 
logical Registers  of  the  Edinburgh  Infirmary,  which  are  kept  with  great  accuracy,  and  the 
result  is,  that  of  657  inspections  there  were  only  28  [4.26%]  in  which  malignant  disease  was 
found  in  one  organ  or  another;  and  this  number  represents  merely  the  relative  frequency 
of  malignant  alterations  of  structure,  not  the  frequency  of  death  from  that  cause.  There 
can  be  no  question  that  the  proportion  thus  arrived  at  is  materially  under  what  the  ex- 
perience of  an  Assurance  Company  would  lead  to,  were  it  susceptible  of  an  equally  rigorous 
scrutiny. 

Assuming  in  the  meantime  that  malignant  disease  accounts  more  or  less  directly  for 
the  death  of  eight  per  cent,  of  the  subjects  of  Assurance  who  die  after  assuring  subse- 
quently to  their  fortieth  year,  it  is  obviously  very  desirable  to  possess  some  means  of 
avoiding  such  risks.  The  resources  for  that  purpose,  which  are  mthin  reach  at  present, 
are  in  general  not  very  precise,  and  perhaps  are  not  often  available.  But  they  are  the 
following: — 1.  The  presence  of  cutaneous  sores  or  excrescences  of  a  dubious  nature — 
indolent  internal  tumors,  possibly  not  occasioning  inconvenience  for  a  time — suspicious 
enlargement  of  the  external  glands — special  symptoms  referrible  to  particular  internal 
organs,  such  as  a  great  liability  to  dyspepsia,  as  being  a  frequent  precursor  of  scirrhus  in 
the  stomach — a  progressive  general  emaciation,  without  apparent  cause,  and  possibly 
even  without  loss  of  strength  or  other  inconvenience  for  some  months:  2.  Proof  of  a  ten- 
dency to  malignant  disease  among  the  members  of  the  immediate  family  of  the  proposer: 
and,  3.  Proof  of  a  tendency  to  scrofulous  diseases  either  in  the  proposer  himself,  or  among 
his  nearest  blood  relations. 

It  is  unnecessary  to  enlarge  upon  any  of  these  criterions  for  the  present.  I  may  merely, 
in  regard  to  the  last  of  them,  refer  to  what  was  said  in  my  former  quinquennial  report  on 
the  apparent  connection  between  the  scrofulous  and  the  cancerous  constitutions,  and  add 
that  further  experience  confirms  me  in  the  belief  in  the  community  of  these  constitutional 
infirmities.  It  is  a  common  idea  with  medical  men,  when  they  grant  health-certificates 
for  the  purpose  of  Assurance,  to  suppose  that  when  a  man  who  is  a  member  of  a  decidedly 
scrofulous  family  reaches  the  age  of  45  or  50  in  a  tolerably  sound  state  of  health,  the  family 
constitutional  failing  may  cease  to  be  regarded.  This  is  a  great  error.  On  watching  the 
history  of  such  cases  narrowly,  it  will  often  be  seen  that  the  constitutional  infirmity  be- 
trays itself  at  last  in  an  unusual  liability  to  organic  diseases  of  internal  organs,  in  an  in- 
ferior power  of  contending  with  diseases  at  large,  or  in  the  actual  development  of  structural 
disease  of  the  majignant  type. 

81 


THE  MORTALITY  FROM  CANCER 

These  observations  would  seem  to  sustain  the  conclusion  that  the 
recorded  mortality  from  cancer  during  the  early  period  of  life  insurance 
experience  was  probably  short  of  representing  with  absolute  complete- 
ness the  total  number  of  deaths  from  malignant  disease,  but  it  is  equally 
clear  that  the  tendency  to  include  non-malignant  diseases  in  the  malig- 
nant group  was  quite  pronounced. 

Scottish  Widows'  Fund  Experience,  1853-1859 

The  Scottish  Widows'  Fund  Society's  experience  for  1853-59  includes 
975  deaths  from  all  causes,  of  which  28  were  specifically  ascribed  to  cancer, 
and  3  additional  deaths  to  tumor.  Cancer  at  this  period  was  usually 
included  in  the  class  of  diseases  of  uncertain  seat,  with  reference  to  which 
it  is  observed  by  Dr.  James  Begbie,  in  a  report  printed  in  1860,  that 

In  this  class  there  is  a  slight  increase, — the  number  of  deaths  from  these  causes  being  59 
on  this  occasion,  and  40  at  the  former  septennial  period,  that  is,  from  5%  to  6  per  cent,  of 
the  total  mortality.  This  increase  arises  mainly  from  one  source,  namely.  Cancer,  under 
which  there  are  28  deaths  against  5  in  our  former  table.  It  is  gratifying  to  find  that,  in 
consequence  of  the  greater  attention  to  accuracy  in  the  returns.  Debility  has  no  place  in 
our  present  investigation,  and  that  Dropsy  only  figures  as  the  cause  of  4  deaths.  The 
causes  which  have  led  to  the  large  addition  to  the  mortality  from  Cancer,  no  doubt  originate 
in  the  same  improvement  in  the  certificates  of  death;  but  they  can  be  traced  also  to  the 
circumstance  that  the  advanced  age  of  the  Society  has  brought  forward  an  increasing 
number  of  risks  to  the  age  at  which  malignant  disease  more  commonly  develops  itself. 
Of  the  28  victims  of  Cancer  who  have  fallen  during  the  present  investigation,  ten  efiFected 
assurance  before  40  years  of  age;  nine  between  40  and  50;  seven  between  50  and  60;  one 
between  60  and  70;  and  one  after  70  years  of  age.  Of  these,  only  one  died  before  40; 
four  between  40  and  50;  five  between  50  and  60;  fifteen  between  60  and  70;  two  between 
70  and  80;  and  one — she  who  assured  at  71 — fell  at  the  ripe  age  of  85.  The  average  ex- 
pectation of  these  parties  was  25.14;  iheir  average  endurance  was  15.41  years.  These 
emerged  risks  embrace  nineteen  males  and  nine  females,  and  are  distributed  over  sixteen 
professions  or  occupations,  two  of  them  only  having  a  double  number.  In  seven  females 
the  disease  affected  the  breast;  in  one,  its  seat  was  in  the  liver;  and  in  another,  in  the 
rectum.  In  one  male  it  manifested  itself  in  the  breast;  in  three,  in  the  abdomen;  in  three, 
in  the  gullet;  in  three,  in  the  rectum;  in  two,  in  the  tongue;  in  two,  in  the  stomach;  in  two, 
in  the  groin;  in  one,  in  the  kidney;  and  in  one,  in  the  lungs.  In  one  only  its  seat  has  not 
been  ascertained. 

There  cannot  be  a  doubt  that,  under  the  name  of  disease  of  the  stomach  and  bowels, 
and  of  the  liver,  lungs,  and  other  internal  organs,  many  certificates  of  death  have  been 
returned,  for  which  Cancer  or  other  malignant  disease  could  more  appropriately  have  been 
substituted  as  the  fatal  cause. 

The  conclusions  of  Dr.  Begbie  are,  therefore,  quite  in  conformity  to 
the  experience  of  the  Standard,  previously  referred  to  at  considerable 
length,  but  the  fact  must  not  be  overlooked  that  these  observations  and 
conclusions  have  reference  to  a  large  portion  of  the  first  half  of  the 
nineteenth  century,  when  the  medical  diagnosis  of  the  causes  of  death 
was  naturally  less  perfectly  developed  than  during  more  recent  years 
of  life  insurance  experience. 

London  Metropolitan  Experience,  1835-1864 

The  London  Metropolitan  experience  was  published  for  the  years 
1835-64,  by  divisional  periods  of  life,  but  not  by  sex.  The  number  of 
deaths  from  all  causes  was  671,  of  which  16, or  2.4  per  cent.,  were  ascribed 
to  cancers,  and  2  additional  deaths,  or  0.3  per  cent.,  to  tumors. 

82 


CANCER  AND  LIFE  INSURANCE 

British  Empire  Mutual  Experience,  1847-1878 

The  early  British  Empire  Mutual  experience  is  for  two  periods,  1847-72 
and  1873-78.  During  the  first  period  there  were  1,999  deaths  from  all 
causes,  of  which  43,  or  2.2  per  cent.,  were  ascribed  to  cancer,  and  14  addi- 
tional deaths,  or  0.7  per  cent.,  were  from  tumors.  In  the  period  1873-78 
there  were  1,179  deaths  from  all  causes,  of  which  36,  or  3.1  per  cent., 
were  attributed  to  cancer,  and  6  deaths,  or  0.5  per  cent.,  to  tumors. 
Subsequently  the  company  published  its  experience  for  1879-84,  but 
without  distinction  of  age  and  sex,  including  a  total  of  1,300  deaths  from 
all  causes,  of  which  42,  or  3.2  per  cent.,  were  from  cancer,  and  10  deaths, 
or  0.8  per  cent.,  were  from  tumors.  The  same  company  published  its 
experience  with  reference  to  publicans  only  for  the  period  1846-76,  in- 
cluding 123  deaths  from  all  causes,  of  which  2,  or  1.6  per  cent.,  were 
deaths  from  cancer,  and  one  additional  death  was  from  tumor. 

The  Gotha  Experience,  1829-1878 

The  Gotha  Life  Insurance  Company  in  1902  published  the  results  of 
its  experience,  by  causes  of  death,  during  the  period  1829-78.  Out  of 
19,080  deaths  from  all  causes,  1,322,  or  6.6  per  cent.,  were  from  malignant 
disease.  In  proportion  to  the  exposed  to  risk,  the  mortality  rate  was 
1.37  per  1,000,  which  compares  with  1.36  for  typhoid  fever  and  3.26  for 
tuberculosis  of  the  lungs.  Omitting  ages  50  and  under,  the  cancer  death 
rate  was  1.31  at  ages  51-55,  2.26  at  ages  56-60,  3.91  at  ages  61-65,  4.92  at 
ages  66-70,  5.74  at  ages  71-75,  4.95  at  ages  76-80  and  5.56  at  ages  81-85. 
The  mortality  from  cancer  is  not  discussed  at  length,  but  it  is  pointed  out 
that  the  specific  nature  of  the  disease  was  not  always  indicated,  so  that 
no  analysis  could  be  made  by  organs  and  parts  of  the  body  affected. 

Considered  by  duration  of  insurance,  but  limiting  the  exposed  to  risk 
to  ages  36-75 ,  inclusive,  it  is  shown  that  the  actual  cancer  mortality  to 
the  expected  during  the  first  year  of  insurance  was  30.0  per  cent. ;  during 
the  2d-5th  years,  inclusive,  it  was  76.4  per  cent.,  and  during  the  6th-10th 
years,  inclusive,  it  was  91.7  per  cent.  It  would,  therefore,  appear  that 
the  mortality  from  cancer  was  reduced  by  medical  selection  during 
the  early  years  of  insurance  duration,  and  as  far  as  it  is  possible  to  judge, 
rather  more  so  than  in  the  aggregate  mortality  experience  of  the  com- 
pany for  durations  of  less  than  six  years. 

King  and  Newsholme's  Medico- Actuarial  Observations 

An  investigation  of  unusual  interest,  with  some  reference  to  insurance 
experience,  was  made  in  1893,  by  Mr.  George  King,  a  Fellow  of  the  Insti- 
tute of  Actuaries,  and  Dr.  Arthur  Newsholme,  the  well-known  author  of 
a  treatise  on  vital  statistics.  The  investigation  was  published  under  the 
title  "On  the  Alleged  Increase  of  Cancer,"  appearing  in  the  Proceedings 
of  the  Royal  Society  for  1893.  For  additional  observations  on  the  inves- 
tigations of  King  and  Newsholme  see  Chapter  III.  The  investigation 
includes  a  study  of  the  experience  of  the  British  Empire  Mutual,  pre- 
viously referred  to,  and  of  the  Scottish  Widows'  Fund,  for  the  period 
1860-87.  The  conclusions  of  these  two  distinguished  authorities  are 
summarized  in  the  statement  that  "The  increase  in  cancer  is  only  appar- 
ent and  not  real  and  is  due  to  improvement  in  diagnosis  and  more 


TEE  MORTALITY  FROM  CANCER 

careful  certification  of  the  causes  of  death.  This  is  shown  by  the 
fact  that  the  whole  of  the  increase  has  taken  place  in  inaccessible 
cancer,  difficult  of  diagnosis,  while  accessible  cancer,  easily  diagnosed, 
has  remained  practically  stationary."  With  the  highest  regard  for  the 
weight  of  opinion  expressed  by  Messrs.  King  and  Newsholme,  I  feel 
constrained  to  hold  that  this  conclusion  is  not  fully  and  clearly 
sustained  by  the  evidence  submitted  by  them,  nor  by  subsequent  ex- 
perience as  derived  either  from  life  insurance  data  or  from  general  sources 
of  information.  The  authors  of  this  frequently  quoted  report  did  not 
thoroughly  examine  the  individual  facts  as  regards  diagnosis  and  death 
certification,  which  would,  in  any  event,  have  been  advisable,  if  not 
absolutely  necessary,  to  substantiate  their  point  of  view.  Their  sugges- 
tion that  trustworthy  statistics  of  cancer  should  in  all  cases  be  based 
upon  an  autopsy  and  a  microscopical  examination  of  the  diseased  parts 
invalidates  all  cancer  statistics,  including  the  very  data  upon  which  they 
rely  to  sustain  their  conclusion  that  the  increase  in  the  cancer  death  rate 
is  only  apparent  and  not  real.  Since  this  conclusion  has  quite  recently 
been  advanced  again  and  brought  to  public  attention  in  this  country, 
it  has  seemed  of  importance  to  refer  to  the  controversy  at  some  length 
elsewhere  in  this  work.  The  argument  was  thoroughly  considered 
by  Dr.  J.  F.  Payne  in  his  Hunterian  Society  lecture,  delivered  on  October 
12, 1898,  whose  conclusions  sustain  the  point  of  view  that  there  has  been 
an  actual  increase  in  cancer  during  recent  years,  measured  with  approxi- 
mate accuracy  by  the  available  statistical  data  on  the  subject. 

Scottish  Widows'  Fund  Experience,  1874-1894 

Not  only  is  the  theory  of  an  actual  increase  in  the  mortality  from  can- 
cer sustained  by  the  mortality  statistics  of  the  general  population,  but 
corresponding  evidence  is  to  be  derived  from  the  experience  of  the 
Scottish  Widows'  Fund  Society,  upon  which  much  reliance  was  placed 
by  Messrs.  King  and  Newsholme  in  the  paper  referred  to.  The  results  of 
an  exhaustive  investigation  of  the  Society's  experience  during  1874-94, 
by  its  medical  officer.  Dr.  Claud  Muirhead,  were  published  in  1902,  in 
which,  after  calling  attention  to  the  increase  in  the  cancer  death  rate  of 
England  and  Wales,  by  divisional  periods  of  life,  during  the  years  1861- 
90,  the  author  draws  attention  to  the  following  facts : 

(1)  It  is  important  to  note  that  here,  as  elsewhere  throughout  this  Report,  deaths 
of  Males  only  are  considered. 

(2)  The  term  "Cancer"  is  employed  as  synonymous  with  "Malignant  Disease," 
and  includes  all  the  various  forms  of  cancer. 

(3)  In  many  cases,  although  Cancer  was  suspected,  the  certificates  of  death  were  very 
indefinite,  and  rendered  it  difficult  to  assign  the  disease  to  its  legitimate  class.  Some  of 
these  unsatisfactory  certificates  were  returned  to  the  grantors  of  them,  with  a  request  for 
further  details,  which  request  was  usually  courteously  responded  to.  In  other  cases, 
where  the  date  of  the  certificate  was  so  remote  that  it  was  unlikely  that  further  informa- 
tion could  be  obtained,  the  details  available  have  been  most  carefully  considered;  and 
where  the  age  of  the  individual  at  death,  the  site  of  the  lesion,  and  the  duration  of  the 
final  illness,  have  seemed  to  offer  reasonable  ground  for  believing  it  to  be  one  of  malignant 
disease,  it  has  been  so  treated,  and  transferred  to  this  sub-heading. 

The  total  number  of  deaths  from  Cancer  among  the  male  lives  assured  in  the  Scottish 
Widows'  Fund  during  the  twenty-one  years  1874-94,  was  539,  equivalent  to  5.883  per  cent, 
of  the  total  mortality.  The  average  age  at  death  was  60.385  years.  The  following  is  a 
comparative  statement  of  the  total  deaths  in  each  of  the  three  Septennia: — 

84 


CANCER  AND  LIFE  INSURANCE 

Scottish  Widows'  Fund  Experience,  1874-1894 


Number  of 
Septennium  Deaths 

1874-1880 122 

1881-1887 165 

1888-1894 252 


Percentage 

of  Deaths 

in  Septennium 

Average  Age 
at  Death 

4.935 

61.980 

5.440 

59.819 

6.889 

59.985 

Two  points  of  interest  are  at  once  apparent  from  this  Table — 

(1)  That,  as  measured  by  the  total  deaths  from  all  causes,  there  has  been  a  very  con- 
siderable increase  in  the  mortality  from  Cancer  among  our  members  during  the  21  years. 
It  is  worthy  of  note  that  the  actual  number  of  deaths  during  1888-94  was  more  than  double 
the  number  during  1874-80. 

(2)  That  there  was  a  very  serious  decrease  in  the  average  age  at  death  from  1874-80 
to  1881-87,  and  a  very  slight  recovery  in  age  from  1881-87  to  1888-94.  This  is  contrary 
to  our  experience  for  deaths  from  all  causes,  the  average  age  at  death  for  the  total  mortality 
in  each  Septennium  being  57.083,  58.105,  and  59.192  years  respectively. 

Before  considering  the  apparent  increase  of  Cancer  among  our  members,  let  us  look  at 
our  rate  of  mortality  from  that  disease  as  compared  with  that  for  England: — 

Annual  Mortality  from  Cancer  in  England  and  the  Scottish  Widows'  Fund 
among  10,000  (Males)  Living  at  Each  Group  of  Ages 

England  Scottish  Widows' 

Groups  of  Ages                                                    1881-90  1874-94 

Between  Ages  20  and  25 57 

25  and  35 79  .82 

"             35  and  45 2.97  2.56 

"             45  and  55 9.98  7.48 

"             55  and  65 22.99  23.99 

65  and  75 37.42  41.91 

Ages  75  and  over 39.14  43.09 

From  this  table  we  see  that  for  the  21  years,  1874-94,  from  Group  55-65  onwards,  our 
death  rate  was  very  considerably  higher  than  that  for  England  for  1881-90.  This  is  a  fact 
to  which  I  shall  refer  later  on. 

I  shall  now  proceed  to  consider  the  question  of  the  apparent  increase  of  Cancer,  as  a 
cause  of  death,  among  our  members  as  compared  with  the  increase  among  the  community. 
For  the  purposes  of  this  comparison  I  have  taken  the  official  figures  for  the  two  decennial 
periods  1871-80  and  1881-90  from  the  Supplementary  Report  referred  to,  because  they  are 
readily  accessible  and  near  enough  in  point  of  time  to  our  own  periods  to  afford  compara- 
tive data: — 

Comparative  Mortality  from  Cancer  in  England  and  the  Scottish  Widows' 
Fund  among  10,000  (Males)  Living  at  All  Ages 


England 

Scottish  Widows' 

Fund  Life  Assurance 

Society 

Period 

Death 
Rate 

Ratio 

Period 

Death 
Rate 

Ratio 

Period 

Death 
Rate 

Ratio 

1871-80.. 

....   3.12 

100 

1874-80 

7.86 

100 

1874-80.... 

..   7.86 

100 

1881-90. . 

. ...   4.30 

138 

1881-87 

8.19 

104 

1888-94.... 

. .  10.42 

133 

Difference 

1.18 

38 

Difference.  .  .  . 

.33 

4 

Difference.  . 

.  .   2.56 

33 

Inspection  of  this  table  brings  out  the  following  facts : — 

(1)  That  the  death  rate  from  Cancer  among  the  General  Population  (Males)  of  England 
increased  38  per  cent,  in  1881-90  as  compared  with  1871-80. 

(2)  That  the  death  rate  among  the  Members  of  the  Scottish  Widows'  Fund — 

(a)  Increased  4  per  cent,  from  1874-80  to  1881-87. 

(6)  Increased  33  per  cent,  from  1874-80  to  1880-94. 
That  the  rate  of  mortality  among  our  members  should  only  have  increased  4  per  cent, 
from  1874-80  to  1881-87  is  surprising,  and,  combined  with  the  fact  that  our  rate  of  mortality 
at  the  older  ages  is  considerably  higher  than  that  for  the  general  population,  appears  to 

85 


THE  MORTALITY  FROM  CANCER 

support  the  theory  that  the  increase  in  Cancer  is  only  apparent.  In  the  Supplement  to 
the  45th  Annual  Report  of  the  Registrar-General  for  England,  issued  in  1885,  Dr.  Ogle, 
commenting  on  the  steady  and  progressive  rise  in  the  mortality  from  Cancer,  remarked: 
"There  can  be  very  little  doubt  that  a  considerable  part  in  this  apparent  increase  is  simply 
due  to  improved  diagnosis,  and  more  careful  statement  of  cause  on  the  part  of  medical 
men.  .  .  The  increase  of  mortality  from  Cancer  has  been  much  greater  among  males 
than  among  females.  .  .  Now,  were  the  rise  not  merely  apparent  but  real,  being  due 
to  general  physical  deterioration  of  the  people  or  other  similar  causes,  there  would  seem 
no  reason  why  the  male  sex  should  have  suffered  more  than  the  female;  whereas  the 
difference  is  readily  intelligible  on  the  hypothesis  that  the  rise  has  been,  at  any  rate  in 
great  measure,  only  apparent  and  due  to  better  diagnosis.  For  the  cancerous  affections 
of  males  are  in  much  larger  proportion  internal,  or  inaccessible,  than  are  those  of  females, 
and  consequently  are  more  diflScult  of  recognition,  so  that  any  improvement  in  diagnosis 
would  add  more  to  the  male  than  to  the  female  reckoning."  This  argument  is  repeated 
by  Dr.  Tatham  in  the  Supplement  to  the  55th  Report.* 

If  this  argument  be  sound,  it  is  evident  that  such  a  large  increase  would  not  be  ex- 
pected among  the  constituents  of  a  Society  like  ours — the  majority  of  whom  can  command 
the  services  of  skilled  medical  men — as  among  the  general  community,  and,  as  stated 
above,  the  small  increase  in  our  death  rate  from  the  first  to  the  second  Septennium  seems 
to  support  this  theory;  but  the  figures  relative  to  1888-94  greatly  diminish  the  force  and 
cogency  of  the  reasoning.  Let  me  repeat  that  every  death  where  there  was  a  suspicion  of 
Cancer  has  been  carefully  investigated,  and  if  necessary  included  under  Cancer,  and  under 
these  circumstances  I  think  it  is  evident  that  the  theory  that  the  large  increase  between 
the  rate  of  mortality  for  1881-87  and  that  for  1888-94—27  per  cent.— was  wholly,  or  even 
largely,  caused  by  a  sudden  increase  of  diagnostic  skill  among  the  class  of  medical  men 
who  usually  certify  causes  of  death  to  the  Society,  is  untenable.  I  am  more  inclined  to 
believe  that,  in  addition  to  the  increase  due  to  more  exact  returns,  there  has  been  a  very 
real  progressive  increase  in  Cancer  as  a  cause  of  death,  and  that  the  small  increase  in  our 
death  rate  for  1881-87,  and  the  large  increase  for  1888-94,  are  accounted  for  by  the  prob- 
ability that  an  increase  in  a  disease  like  Cancer  would  show  itself,  first  among  the  general 
population,  and  last  among  selected  lives.f 

There  is  another  aspect  of  the  case  to  be  considered,  and  one  where  our  statistics 
directly  controvert  the  reasoning  of  those  who  think  that  the  increase  in  cancer  is  only 
apparent. 

It  has  been  sought  to  support  this  proposition  by  the  statement  that  it  is  Cancer  of  the 
internal  organs  which  is  largely  on  the  increase.  These  cases  being  obviously  more  diffi- 
cult to  recognize  than  corresponding  affections  of  the  external  organs,  the  increase  is 
ascribed  to  improved  skill  in  diagnosis  on  the  part  of  the  Reporters. 

Before  proceeding  to  examine  our  statistics  as  to  the  truth  or  fallacy  of  this  statement, 
it  will  be  convenient  to  explain  which  lesions  are  regarded  as  External,  and  which  as  In- 
ternal. The  arrangement  is  somewhat  arbitrary,  but  is  based  upon  the  accessibility  or 
non-accessibility  of  the  parts  to  touch  and  sight.  Hence  the  accessible  lesions  are  styled 
External,  the  deeper  and  non-accessible  lesions.  Internal.  As  an  Example  of  the  External, 
Cancer  of  the  Tongue  may  be  cited,  and  of  the  Internal,  Cancer  of  the  Stomach. 

We  have  in  all  539  cases  of  Cancer  to  deal  with,  but  for  our  present  purpose  27  of  these 
must  be  deducted,  as  in  them  the  site  of  the  disease  was  not  specified,  thus  leaving  512 
cases  in  which  the  site  of  the  lesion  was  detailed.  The  following  Table  shows  these  512 
deaths  subdivided  into  Cancer  of  the  Internal  and  Cancer  of  the  External  Organs  for  the 
three  Septennia,  separately  and  combined;  and  the  percentages  which  these  numbers 
bear  to  the  total  in  each  period  of  time.  The  differences  between  the  Ratios  show  the 
variations  per  cent,  of  these  percentages,  and  indicate  the  increase  or  decrease  per  cent, 
from  the  first  Septennium. 

•For  an  extended  discussion  of  the  precbe  classification  of  cancer  deaths  as  to  whether  of  the  accessible, 
inaccessible  or  intermediate  organs  or  parts,  see  Chapter  I  and  Table  8,  Appendix  A. 

fl  have  quite  fully  discussed  the  question  of  accuracy  and  completeness  in  American  death  registration  in  an 
address  at  the  Jacksonville  meeting  of  the  American  Public  Health  Association  (1914).  The  results  of  an 
original  investigation  of  autopsy  records  compared  with  the  clinical  diagnoses  will  in  course  of  time  be  published 
by  the  Johns  Hopkins  Hospital,  of  Baltimore,  Md.,  including  about  5,000  cases,  thoroughly  and  critically  con- 
sidered by  members  of  the  medical  department  of  The  Prudential  Insurance  Company  of  America.  This 
investigation  is  practically  certain  to  add  materially  to  the  existing  state  of  knowledge  regarding  the  accuracy 
and  completeness  of  death  certification  in  a  typical  and  representative  city  of  America.  The  investigation  is 
made  jointly  under  the  direction  of  Dr.  M.  C.  Winternitz,  resident  pathologist  of  the  Johns  Hopkins  Hospital, 
Dr.  Walter  A.  Jaquith,  Medical  Director  of  The  Prudential  and  myself. 

86 


CANCER  AND  LIFE  INSURANCE 

Scottish  Widows'  Fund  Experience,  1874-1894 
Mortality  from  Cancer  of  the  Internal  and  External  Organs 


Period 

1874-80 
1881-87 
1888-94 

1874-94 


Deaths  fhom  Cancer  of  the 
Internal  Organs 


Number  Percentage  Ratio 

81     71.05  100.00 

107    70.86  99.73 

162    65.58  92.30 


350 


68.36 


Deaths  from  Cancer  of  the 
ExTEHNAii  Organs 


Number  Percentage  Ratio 

33    28.95  100.00 

44    29.14  100.66 

85     34.42  118.89 


162 


31.64 


Total  Deaths 
from  Cancer 
Where  Site  of 

Disease 
Was  Specified 

114 
151 

247 

512 


From  this  it  appears  that  the  deaths  from  Cancer  of  the  Internal  Organs  amounted  to 
71.05  per  cent,  of  the  total  specified  cases  in  the  first  Septennium,  and  to  65.58  per  cent. 
in  the  third  Septenniimi,  equal  to  a  decrease  of  7.70  per  cent,  of  the  percentage  value  of  the 
first;  while  the  deaths  falling  into  the  External  class  formed  in  the  first  Septennium  28.95 
per  cent,  of  the  specified  cases,  and  34.42  per  cent,  in  the  third  Septennium,  equal  to  an 
increase  of  18.89  per  cent,  over  the  percentage  value  of  the  first. 

The  next  Table  shows  that  the  increase  in  the  death  rate  fully  supports  the  results 
obtained  by  comparing  the  percentages  of  actual  deaths. 

Scottish  Widows'  Fund  Experience,  1874-1894 

Mortality  from  Cancer  of  Internal  and  External  Organs,  Separately 

and  Combined,  among  10,000  (Males)  Living  at  All  Ages 


Period 

1874-80 
1881-87 
1888-94 


Internal,  Organs 


Death  Rate  Ratio 

5.22  100.00 

5.31  101.72 

6.70  128.35 


External  Organs 


Death  Rate 
2.12 
2.18 
3.52 


Ratio 

100.00 
102.83 
166.04 


Total 


Death  Rate  Ratio 

7.34  100.00 

7.49  102.04 

10.22  139.24 


The  statement  made  by  Dr.  Ogle  and  repeated  by  Dr.  Tatham,  that  the  chief  increase 
in  the  mortality  from  Cancer  among  the  community  was  due  to  the  multiplication  of  male 
deaths,  may  be  accepted  without  question;  but  our  statistics  do  not  support  their  conten- 
tion that  the  additional  deaths  belonged  to  the  Internal  or  Inaccessible  Group,  and  in  our 
Society  our  Reporters  can  not  lay  claim  to  any  enlarged  knowledge  or  greater  skill  by 
reason  of  an  additional  nimiber  of  cases  of  Internal  Cancer  being  diagnosed. 

Going  into  detail,  the  two  following  Tables  show  the  deaths  from  Cancer  among  our 
members  during  the  three  Septennia,  separately  and  combined,  subdivided  among  the 
organs  affected;  and  the  percentages  these  numbers  bear  to  the  total  deaths  from  Cancer 
where  the  site  of  the  disease  was  specified,  in  each  period  of  time. 

Scottish  Widows'  Fund  Experience,  1874-1894 
Mortality  from  Cancer  of  the  Internal  Organs 

1874-80  1881-87  1888-94  1874-94 

Organ  Affected                          No.  Per  Cent.  No.  Per  Cent.  No.  Per  Cent.  No.  Per  Cent. 

Stomach 28  24.56  33  21.85  50  20.24  111  21.68 

Liver 23  20.18  28  18.55  42  17.00  93  18.17 

Bowel 5  4.39  15  9.93  23  9.31  43  8.40 

Abdomen 7  6.14  13  8.60  14  5.67  34  6.64 

Bladder 5  4.39  3  1.99  8  3.24  16  3.13 

Mediastinum  and  thorax 1  0.88  8  5.30  4  1.62  13  2.54 

(Esophagus 2  1.75  2  1.33  8  3.24  12  2.34 

Prostate 3  2.65  2  1.33  3  1.21  8  1.56 

Kidneys 2  1.75  1  0.66  4  1.62  7  1.37 

Pancreas 3  2.63  ..  ..  3  1.21  6  1.17 

Lung 2  1.75  1  0.68  2  0.81  5  0.98 

Brain . .  . .  . .  1  0.41  1  0.19 

Spinal  cord ..  1  0.66  ..  ..  1  0.19 

Total .- 81       71.05     107       70.86     162       65.58     350       68.36 


87 


TEE  MORTALITY  FROM  CANCER 


Scottish  Widows'  Fund  Experience,  1874-1894 
Mortality  from  Cancer  of  the  External  Organs 


1874-80 

1881-87 

1888-94 

1874-94 

Organ  Affected 

No. 

Per  Cent. 

No. 

Per  Cent. 

No. 

Per  Cent. 

No. 

Per  Cent. 

Rectum 

...      12 

10.52 

7.02 

26 

2 

17.22 
1.33 

30 
13 

12.14 
5.26 

68 
23 

13  28 

Tongue 

...       8 

4.49 

Tissues 

...       4 

3.51 

5 

3.31 

8 

3.24 

17 

3.32 

Throat 

...       3 

2.63 

1 

0.66 

5 

2.02 

9 

1.76 

Larynx 

...       1 

0.88 

1 

0.66 

6 

2.43 

8 

1.56 

Bones 

1 

0.66 

6 

2.43 

7 

1.37 

Mouth 

1 

0.88 

2 

1.33 

2 

0.81 

5 

0.98 

Partoid 

...       3 

2.63 

1 

0.66 

1 

0.41 

5 

0.98 

Glands 

1 

0.66 

4 

1.62 

5 

0.98 

Penis 

1 

0.88 

2 

1.33 

1 

0.41 

4 

0.78 

Jaw 

4 

1.62 

4 

0.78 

Testes 

2 

0.81 

2 

0.39 

Eye 

1 

0.66 

1 

0.41 

2 

0.39 

Lip 

2 

0.81 

2 

0.39 

Skin 

1 

0.66 

1 

0.19 

Total 

...     33 

28.95 

44 

29.14 

85 

34.42 

162 

31.64 

Let  us  now  consider  the  question  of  the  age  at  death  of  those  of  our  members  who  died 
of  Cancer. 

We  have  already  seen  that  the  average  age  at  death  was  considerably  younger  in  1881- 
87  and  1888-94  than  in  1874-80.  The  following  shows,  by  means  of  percentages,  at  what 
groups  of  ages  the  changes  occurred: — 

Scottish  Widows'  Fund  Experience,  1874-1894 

The  Percentages  at  Groups  of  Ages  of  the  Total  Number  of  Deaths  from 

Cancer  in  Each  Septennium 


Between 

Between 

Between 

Between 

Between 

Septennium                      gg^"^ 

Ages 

Ages 

Ages 

Ages 

Ages 

Ages  75 

25  and  35 

35  and  45 

45  and  55 

55  and  65 

65  and  75 

and  Over 

1874-80 

1.64 

8.20 

12.30 

33.60 

36.88 

7.38 

1881-87 

1.21 

9.09 

19.39 

37.58 

23.64 

9.09 

1888-94 

2.78 

8.73 

21.83 

31.75 

25.79 

9.12 

Variations  in  incidence  of 

Mortality  for  1874-80 

and  for  1888-94 

+1.14 

+0.53 

+9.53 

-1.85 

-11.09 

+1.74 

The  next  table  is  a  truer  test  of  the  incidence  of  the  Cancer  Mortality,  for  it  takes  into 
account  not  only  the  actual  deaths,  but  also  the  number  of  living  who  were  exposed  to  the 
risk  of  death  for  one  year,  and  it  practically  reproduces  in  another  form  all  the  really 
important  features  of  the  preceding  table. 

Scottish  Widows'  Fund  Experience,  1874-1894 
Annual  Mortality  from  Cancer  among  10,000  (Males)  Living  at  Each  Group 

of  Ages  and  at  All  Ages 


Period 

1874-80 
1881-87 

1888-94 


Ages 
under 


Between  Between  Between  Between  Between 

Ages            Ages            Ages            Ages  Ages 

25  and  35  35  and  45  45  and  55  65  and  65  65  and  75 

0.51          2.19          4.72          20.78  46.98 

0.42         2.37         7.34          25.89  33.67 

1.49          2.95          9.02         24.53  45.18 


Ages  75 
and  over 


All  Ages 
7.86 
42.22         8.19 
48.33        10.42 


34.68 


These  tables  unmistakably  show  that  the  age  at  which  Cancer  must  be  looked  upon  as  a 
serious  cause  of  death  among  our  members  is  becoming  younger.  This  fact  is  more  strongly 
brought  out  by  grouping  together  a  larger  number  of  ages  at  death.  From  the  table 
showing  the  percentages  at  groups  of  ages  we  see  that  practically  90  per  cent,  of  all  our 
deaths  from  Cancer  took  place  between  ages  35  and  75.     If,  therefore,  we  group  the 


88 


CANCER  AND  LIFE  INSURANCE 


deaths  between  these  ages,  the  results  will  be  probably  more  satisfactory  than  if  we  in- 
clude the  extremities  of  the  table,  because  we  shall  then  have  eliminated  what  we  may  call 
"accidental"  cases  of  death  among  our  very  old  or  very  young  members.  A  few  cases  of 
death  at  either  end  included  in  a  table  like  the  following  might  have  the  effect  of  put- 
ting our  view  of  the  essential  facts  entirely  out  of  focus. 

Scottish  Widows'  Fund  Experience 
Proportionate  and  Relative  Mortality  from  Cancer,  1874-1894 


PERCENTAGE  OF  DEATHS  IN  GROUPS  OF  AGES  TO  TOTAL  CANCE8 
DEATHS  IN  EACH  SEPTENNIUM 


ANNUAL  MORTAL  ITT  AMONG  10,000(MALES) 
LIVING  AT  EACH  GROUP  OF  AGES 


Period 

1874-80 
1881-87 
1888-94 


Between 
Ages  35  and  55 
Per  Cent.      Ratio 
20.50         100 
28.48         139 
30.56         149 


Between 
Ages  55  and  75 
Per  Cent.      Ratio 
70.48         100 
61.22  87 

57.54  82 


Between  Between 

Ages  35  and  55  Ages  55  and  75 

Death  Rate    Ratio  Death  Rate    Ratio 

3.23         100  29.35       100 

4.40         136  28.43         97 

5.63         176  30.85       105 


Consideration  of  the  first  half  of  this  table  shows  us  that  the  actual  number  of  deaths 
from  Cancer  during  1874-94  was  steadily  and  rapidly  transferred  from  Group  55-75  to 
Group  35-55,  while  the  figures  in  the  second  half  of  the  table  show  that  the  increase  in  our 
rate  of  mortality  was  almost  entirely  confined  to  members  under  55  years  of  age,  the 
increase  in  the  dearth  rate  among  the  members  between  55  and  75  years  of  age,  from  1874-80 
to  1888-94,  being  only  5  per  cent.,  while  for  the  other  group  it  was  76  per  cent. 

Medical  Observations  and  Conclusions  Regarding  Cancer  Increase 

Reviewing  the  data  which  have  been  submitted,  the  following  conclusions  seem  to  be 
justified — 

1.  The  registered  increase  in  themumber  of  deaths  from  Can,cer  is  tmdoubted.  This  is 
proved  by  our  own  statistics,  and  corroborated  by  all  other  authorities. 

2.  After  "allowing  that  this  increase  is  not  wholly  real,  but  may  be  accounted  for,  to 
some  extent,  on  the  assumption  that  the  true  nature  of  obscure  cases  of  malignant  disease 
has  been  recognized  with  ever-increasing  certainty  in  recent  years,  and  that,  as  a  con- 
sequence, the  statement  of  death  has  been  made  with  greater  precision  than  had  been 
formerly  the  case,"  there  remains  a  large  real  increase  to  account  for  the  large  and  pro- 
gressive mortality  from  this  disease. 

3.  The  Age  Period  at  which  death  from  Cancer  is  most  frequent  is  gradually  declining 
according  to  the  Scottish  Widows'  Fund  Returns. 

4.  The  average  age  at  death  from  Cancer  among  our  members  declined  by  two  years 
from  1874-80  to  1888-94,  as  contrasted  with  a  rise  in  the  average  age  at  death  from  all 
causes  of  a  little  over  two  years. 

5.  The  Office  returns  mark  a  decrease  in  deaths  from  Internal  Cancer  of  7.70  per  cent., 
and  an  increase  in  deaths  from  External  Cancer  of  18.89  per  cent,  of  the  percentages  in  the 
First  Septennium  as  contrasted  with  the  Third. 

Highly  interesting  as  are  these  statistics,  they  partake  more  of  scientific  than  of 
practical  value.  They  do  not  enlighten  us  as  to  how  we  may  diminish  our  mortality  from 
this  ever-increasing  cause  of  death.  We  learn  from  them,  however,  that  during  the  twenty- 
one  years  under  observation.  Cancer  as  a  cause  of  death  among  our  members  aged  from  45 
to  65  has  made  rapid  and  startling  progress.  If  we  compare  1874-80  with  1888-94,  we  find 
that  practically  one-third  of  all  our  deaths  by  Cancer  occurred  between  ages  55  and  65 
in  each  Septennium,  but  that  a  great  change  took  place  in  Groups  45-55  and  65-75,  the 
figures  for  the  first  group  increasing  from  12  per  cent,  to  22  per  cent.,  and  in  the  last  de- 
creasing from  37  per  cent,  to  26  per  cent.  Again,  the  rate  of  mortality  was  nearly  doubled 
for  Group  45-55,  and  increased  by  18  per  cent,  for  Group  55-65,  while  remaining  practically 
constant  for  Group  65-75.  These  facts  may  help  us  when  a  proposal  is  made  to  the 
Society,  in  which  the  proposer  states  that  one,  or  even  two,  of  his  predecessors  died  from 
Cancer.  For  although  our  Records  show  that  only  about  8  per  cent,  of  our  Members  who 
died  of  Cancer  during  the  twenty-one  years  under  observation  stated  in  their  Pro- 
posal Sheets  that  some  near  relative  had  died  of  Malignant  Disease,  the  high  age  at  which 
cancer  ends  fatally  would  prevent  their  family  history  being  anything  like  complete  at  the 
time  they  proposed  for  assurance;  and  the  general  consensus  of  opinion  goes  to  show  that 
heredity  has  a  certain  importance  in  Cancer,  and  cannot  be  wholly  disregarded,  although 
it  cannot  be  denied  that  less  weight  is  attached  to  it  now  than  in  former  days.    If,  then, 

89 


THE  MORTALITY  FROM  CANCER 

a  proposer  whose  family  history  is  tainted  as  indicated,  desires  a  PoUcy  on  the  Endowment 
Assurance  Scale,  maturing  at  age  45  or  50,  I  consider  that  this  family  history  of  Cancer 
may  be  entirely  ignored.  But  if  the  policy  asked  for  be  an  Endowment  Assurance  matur- 
ing at  an  older  age,  or  a  Whole  Life  Assurance,  it  is  a  question  whether  such  a  proposal 
should  be  accepted  at  ordinary  rates.  The  mortality  from  Cancer  rapidly  appreciates 
after  age  50,  and,  after  careful  consideration,  I  am  of  opinion  that  probably  the  best  way 
of  treating  such  a  proposal  would  be  to  accept  it  on  the  Endowment  Assurance  Scale  at  age 
55  or  death. 

The  experience  for  each  Septennium  is  briefly  presented  in  the  following  summary 
observations: 

1874-80. — To  this  terrible  disease  122  members  fell  victims — a  number  equivalent  to 
4.935  p>er  cent,  of  the  septennial  mortality.  The  average  age  at  death  was  61.980.  Twelve 
of  these  members  stated  in  their  Proposal  Sheets  that  either  father  or  mother  had  died  of 
Cancerous  affections. 

1881-87. — During  this  Septennimn  165  members  died  from  Cancer,  equivalent  to 
5.440  per  cent,  of  the  septennial  mortality.  The  average  age  at  death  was  59.819.  Ten 
stated  that  either  father  or  mother  had  died  of  Cancer. 

1888-94.— The  number  of  deaths  due  to  this  cause  was  252,  equivalent  to  6.889  per 
cent,  of  the  septennial  mortality.  The  average  age  at  death  was  practically  the  same  as 
in  the  previous  Septennium,  viz.,  59.985  years.  Twenty  of  the  deceased  admitted  a  family 
history  of  Cancer  at  date  of  Assurance. 

On  account  of  their  exceptional  value,  these  observations  by  a  thor- 
oughly qualified  medical  officer  of  one  of  the  foremost  life  insurance  in- 
stitutions in  the  world  have  been  given  in  full,  since  the  original 
publication  is,  as  a  rule,  not  conveniently  available.  They  require  to 
be  taken  into  account  by  all  who  rely  primarily  for  their  conclusions 
regarding  the  increase  in  cancer  upon  more  or  less  inadequate  statistical 
data  and  who  blindly  accept  the  findings  of  Messrs.  King  and  News- 
holme,  of  a  date  since  which  the  general  cancer  death  rate  has  continued 
to  increase,  not  only  in  England  and  Wales,  but  in  practically  every 
civilized  country  of  the  world. 

London  Prudential  Experience,  1867-1870 

Some  interesting  experience  data  were  published  in  London  in  1871 
under  the  title  "Mortality  Experience  of  the  Prudential  Assurance  Com- 
pany, in  the  Industrial  Branch,  for  the  Years  1867-70,  with  Observations 
by  Henry  Harben."  This  experience  included  17,399  deaths  of  males 
from  all  causes  and  17,773  deaths  of  females.  The  number  of  male 
deaths  from  cancer  was  138,  or  0.79  per  cent.,  and  of  female  deaths,  352, 
or  1.98  per  cent.  The  experience  includes  almost  exclusively  lives  of  the 
working  class,  which  at  that  period  was  in  a  much  less  satisfactory 
economic  condition  than  at  the  present  time.  Since  the  mortality  from 
cancer  is  apparently  more  common  among  the  well-to-do  than  among 
the  poor  or  wage-earning  element,  these  early  statistics  of  the  London 
Prudential  are  of  some  practical  value  in  connection  with  the  present 
inquiry.* 

Mutual  Life  Insurance  Company  Experience,  1843-1873 

The  Mutual  Life  Insurance  Company  of  New  York,  in  1877,  published 
the  results  of  its  mortuary  experience  for  the  period  1843-73.     The 

*For  observations  on  the  comparative  cancer  mortality  of  the  rich  and  the  poor,  see  "Natural  History  of  Can- 
cer," by  W.  R.  Williams.  There  are  numerous  references  to  the  subject  in  this  work,  under  the  index  title 
"Wealth  in  relation  to  cancer  proclivity."  The  collective  evidence  seems  to  favor  the  view  that  the  well-to-do 
are  more  liable  to  cancer  than  the  poor.  The  same  subject  is  discussed  in  the  third  volume  of  the  treatise  by 
J.  Wolff,  who  refers  to  the  earlier  investigations  by  Tanchou  and  Walshe  and  the  more  recent  inquiries  by 
Braithwaite,  who  maintains  that  there  is  a  distinct  correlation  between  excessive  meat  consumption  and  can- 
cer frequency;  but  the  data  upon  which  these  conclusions  are  based  must  be  considered  inadequate  to  the  purpose. 

00 


CANCER  AND  LIFE  INSURANCE 

number  of  deaths  of  males  from  all  causes  was  5,223,  of  which  94,  or 
1.80  per  cent.,  were  deaths  from  cancer.  There  were  8  deaths  from 
cancer  among  the  162  females  who  died  during  the  period  referred  to, 
or  4.94  per  cent.  Considering  that  the  class  of  risks  dealt  with  was 
representative  of  the  more  prosperous  or  well-to-do  element  of  the 
population,  subject  to  more  trustworthy  methods  of  medical  diagnosis 
and  death  certification  than  the  population  at  large,  it  is  significant 
that  the  number  of  deaths  from  cancer  should  have  been  less  than  2  per 
cent,  for  insured  males.  In  view  of  the  unusually  low  mortality,  the 
medical  observations  by  the  authors  of  the  report  referred  to  are  of  some 
interest  and  therefore  given,  in  part,  as  follows : 

We  had  previously  shown  that  the  mortaUty  from  Cancer  compared  with  that  from  all 
causes  was  small  for  the  first  five  years  of  insurance,  and  became  very  much  greater  after 
that  periofd.  Cancer  is  usually  chronic  in  its  course,  often  taking  years  before  the  final 
fatal  result.  Hence  the  medical  examination  eliminating  those  already  affected  with  the 
disease,  it  will  be  only  after  a  few  years  have  elapsed  that  there  can  be  many  deaths  from 
Cancer.  We  find,  however,  one  marked  exception  to  this  rule :  the  mortality  in  the  first 
year  after  insurance  is  remarkably  high,  being  double  that  of  the  second  year.  This  may 
be  merely  a  matter  of  chance,  on  account  of  the  small  number  of  figures;  but  it  is  most 
probable  that  the  disease  existed  at  the  time  of  insurance,  and  that  the  applicants  denied 
or  concealed  their  symptoms  from  the  scrutiny  of  the  medical  examiners. 

The  relatively  high  mortality  from  cancer  during  the  first  year  of 
insurance  is  not  confirmed  by  subsequent  insurance  experience,  but  it 
must  be  taken  into  consideration  that  the  actual  experience  of  the 
company  was  relatively  small.  Aside  from  the  foregoing  observations 
it  is  pointed  out  in  the  report  that  the  proportionate  mortality  from 
cancer  was  higher  among  foreigners  than  among  natives  and  that  there 
had  been  only  three  cases  in  which  there  was  a  family  history  of  the 
disease.  The  concluding  observations  on  cancer  in  relation  to  medical 
selection  are  in  part: 

Although,  as  we  have  seen,  the  difference  in  the  mortality  from  Cancer  among  the 
insured  and  general  population  is  very  great,  still  it  is  not  a  disease  which  we  would  expect 
to  be  much  influenced  by  medical  selection.  The  etiology  of  Cancer  is  too  obscure  to 
enable  us  to  detect  the  probabilities  of  its  approach.  Age,  inheritance,  occupation,  and 
perhaps  climate  and  nationality,  have  some  influence  on  its  causation;  but,  in  the  words  of 
Sir  James  Paget,  "After  all,  when  we  have  assigned  to  these  conditions  their  full  weight  in 
producing  the  cancerous  constitution  or  state  of  the  blood,  that  which  may  strike  us  most 
of  all  is  the  comparatively  small  influence  which  any  known  internal  or  external  conditions 
possess." 

Washington  Life  Insurance  Company  Experience 

The  Washington  Life  Insurance  Company  published  a  volume  of 
actuarial  and  medical  statistics  in  1889,  including  an  analysis  of  2,000 
consecutive  deaths,  of  which  68,  or  3.4  per  cent.,  had  been  deaths  from 
cancer.  There  were  also  7  additional  deaths  from  tumors,  equivalent  to 
0.35  per  cent,  of  the  mortality  from  all  causes.  The  report  includes 
many  interesting  observations  on  the  relation  of  family  history  to  the 
disease  and  the  value  of  medical  selection,  but  the  number  of  deaths 
considered  is  unfortunately  too  small  to  warrant  the  acceptance  of  these 
conclusions  as  entirely  trustworthy  at  the  present  time.  It  may  be 
quoted,  however,  from  the  report,  that 

Although  cancer  is  usually  classed  among  hereditary  diseases,  there  is  a  wide  difference 
of  opinion  among  authorities  as  to  the  exact  part  played  by  the  hereditary  taint  in  the 
causation  of  the  disease.    Velpeau  believed  that  one  in  three  cases  of  cancer  showed  an 

91 


THE  MORTALITY  FROM  CANCER 

inherited  predisposition;  Sir  James  Paget's  investigation  yielded  one  in  four;  Mr.  Sibley 
concluded  from  the  statistics  of  the  Middlesex  Hospital  that  the  proportion  was  less  than 
one  in  twelve;  the  late  Willard  Parker  found  a  record  of  cancer  in  the  family  of  only  56  out 
of  397  cases  of  cancer  of  the  breast  operated  on  by  him.  He  expressed  it  as  his  well  con- 
sidered opinion  that  cancer  is  not  a  hereditary  disease. 

In  the  experience  of  the  Washington  Life  Insurance  Company,  out  of 

2.000  deaths  from  all  causes,  56  were  deaths  of  persons  with  cancer 
in  the  family  history ;  but  out  of  68  deaths  from  cancer  in  the  company's 
experience,  only  one  death  was  of  a  person  with  a  history  of  cancer  in  the 
family.  It  was  therefore  shown  by  this  experience  that  the  data '  'support 
the  opinion  that  has  been  gaining  ground  of  late  among  medical  men, 
namely,  that  the  hereditary  element  is  not  such  an  important  factor  in 
the  production  of  cancer  as  was  formerly  believed."  It  may  be  stated 
in  this  connection  that  the  average  age  at  entry  of  the  56  cases  with  a 
family  history  of  cancer  was  43  years,  and  the  average  age  at  death, 
52.62  years,  giving  an  average  policy  duration  of  9.62  years,  in  compari- 
son with  an  average  policy  duration  for  the  2,000  deaths  from  all  causes 
of  8.54  years.  This  experience,  therefore,  limited  as  it  was,  seemed  to 
warrant  the  conclusion  that  "Regarded  from  the  standpoint  of  life  in- 
surance, a  death  from  cancer  in  the  family  record  of  an  applicant  does 
not  necessarily  prejudice  the  risk  in  any  respect." 

Greshatn  Company  Experience 

An  earlier  experience  is  that  of  The  Gresham  Life  Assurance  Society, 
published  in  1868,  including  1,000  deaths  from  all  causes,  of  which  21,  or 

2.1  per  cent.,  were  deaths  from  cancer.  In  addition,  however,  there 
were  4  deaths  from  tumors,  equivalent  to  0,4  per  cent. 

Clergy  Mutual  Experience,  1829-1887 

A  more  conclusive  experience  is  that  of  the  Clergy  Mutual  Assurance 
Society  for  the  period  1829-87,  published  in  1891,  including  2,119  deaths 
from  all  causes,  of  which  102,  or  4.8  per  cent.,  were  deaths  from  cancer. 
In  addition,  the  society  recorded  71  deaths  in  its  experience  with  sub- 
standard lives,  but  of  this  number  only  2,  or  2.8  per  cent.,  were  deaths 
from  cancer. 

Mutual  Life  Experience,  1843-1898 

The  combined  experience  of  The  Mutual  Life  Insurance  Company  of 
New  York  for  the  period  1843-98,  was  published  in  1900,*  including 
44,985  deaths  of  males,  of  which  1,882,  or  4.18  per  cent.,  were  deaths  from 
cancer.  In  the  same  experience  there  were  1,540  deaths  of  females,  of 
which  127,  or  8.25  per  cent.,  were  deaths  from  cancer.  In  addition 
thereto  there  were  in  the  male  experience  120  deaths  from  tumors,  or 
0.27  per  cent,  of  the  deaths  from  all  causes;  and  in  the  female  experience 
there  were  8  deaths  from  tumors,  equivalent  to  0.52  per  cent.  The  can- 
cer mortality,  by  divisional  periods  of  life,  is  given  in  full  in  the  table 
following : 

*Report  Exhibiting  the  Experience  of  The  Mutual  Lite  Insurance  Company  of  New  York  for  fifteen  years 
ending  February  1,  1858,  New  York,  November,  1858.  Report  on  the  Mortality  Records  of  The  Mutual  Life 
Insurance  Company  of  New  York,  1843-1914,  New  York,  1900.      (See  Tables  32-33,  Appendix  D.) 


CANCER  AND  LIFE  INSURANCE 


Cancer  Mortality  Experience  of 

The 

Mutual  Life  Insurance  Company  of  New  York, 

1843-1898 

MALES 

FEMALES 

Ages  at  Death 

All  Causes 

Cancer 

Per  Cent. 

All  Causes 

Cancer 

Per  Cent. 

Under  20. 

38 

2 

20-24.. 

569 

3 

0.53 

30 

25-29 . 

1,775 

10 

0.56 

78 

30-34 . . 

2,900 

34 

1.17 

136 

1 

0.73 

35-39 . 

4,034 

81 

2.01 

141 

6 

4.26 

40-44 . 

4,307 

128 

2.97 

175 

18 

10.29 

45-49 . 

4,621 

180 

3.90 

156 

19 

12.18 

50-54 . 

4,944 

253 

5.12 

159 

25 

15.72 

55-59 . 

5,283 

331 

6.27 

185 

21 

11.35 

60-64. 

5,016 

305 

6.08 

160 

17 

10.63 

65-69 . 

4,593 

273 

5.94 

122 

8 

6.56 

70-74. 

3,406 

170 

4.99 

71 

9 

12.68 

75-79 . 

2,212 

89 

4.02 

92 

1 

1.08 

80-84 . 

956 

23 

2.41 

25 

2 

8.00 

85  and  over 309 

2 

0.65 
4.18 

7 

127 

•• 

All  ages 

44,985* 

1,882 

l,540t 

8.25 

•Including  22  age  not  stated,   flncluding  1  age  not  stated. 

According  to  this  experience  the  proportionate  mortality  was  highest 
for  males  at  ages  55-59,  when  it  was  6.27;  and  for  females  at  ages  50-54, 
when  it  was  15.72  per  cent.  The  proportionate  mortality  from  cancer 
during  four  periods  of  time  is  shown  below. 

Cancer  Mortality  Experience  of 
The  Mutual  Life  Insurance  Company  of  New  York,  1843-1898 


MALES 

All  Ages 

Ages 

Under  45 

Ages  45  and  Over 

Deaths  from 

C 

incer 

Deaths  from 

C 

ancer 

Deaths  from 

C 

ancer 

All  Causes 

No. 

Per  Cent. 

All  Causes 

No. 

Per  Cent. 

All  Causes 

No, 

Per  Cent. 

1843-73. 

. .     5,223* 

94 

1.80 

2,674 

25 

0.93 

2,527 

69 

2.72 

1874-85. 

..    10,839 

449 

4.14 

3,028 

71 

2.34 

7,811 

378 

4.84 

1886-93. 

..   14,568 

631 

4.33 

3,658 

65 

1.78 

10,910 

566 

5.19 

1894-98. 

..    14,355 

708 

4.93 
4.18 

4,263 

95 
256 

2.23 
1.88 

10,092 

613 

6.07 

1843-98. 

.  .  44,985* 

1,882 

13,623 

31,340 

1,626 

5.19 

FEMALES 

1843-73. 

162t 

8 

4.94 

76 

5 

6.58 

85 

3 

3.53 

1874-85. 

ai 

24 

9.72 

74 

4 

5.41 

173 

20 

11.56 

1886-93. 

456 

45 

9.87 

147 

10 

6.80 

309 

35 

11.33 

1894-98. 

675 

50 
127 

7.41 
8.25 

265 
562 

6 
25 

2.26 
4.45 

410 

977 

44 
102 

10.73 

1843-98 . 

. .     l,540t 

10.44 

'Including  22  age  not  stated,    flncluding  1  age  not  stated. 


Northwestern  Mutual  Experience,  1857-1909 

Among  more  recent  data  are  the  statistics  of  the  Northwestern 
Mutual  Life  Insurance  Company  for  the  periods  1857-85  and  1886-1909. 
The  proportionate  mortality  from  cancer  during  the  first  period  was 


93 


TEE  MORTALITY  FROM  CANCER 

3.4  per  cent.,  against  5.8  per  cent,  during  the  last.  Naturally,  in  the 
case  of  this  as  in  the  experience  of  some  of  the  other  companies  referred 
to,  the  increasing  average  age  of  the  insured  and  a  possibly  larger  pro- 
portion of  persons  insured  at  ages  40  and  over  would  tend,  in  part  at  least, 
to  bring  about  an  increased  proportionate  mortality  from  cancer, 
but  there  are  reasons  for  believing  that,  if  the  required  correction  were 
made,  that  the  more  recent  experience  would  exhibit  an  actual  in- 
crease in  the  cancer  death  rate  over  earlier  years. 

German  Germania  Experience,  1857-1894 
A  large  amount  of  additional  statistical  information  on  the  subject  of 
cancer  is  available  for  American  and  foreign  insurance  companies,  but 
the  data  can  be  only  very  briefly  referred  to.  The  experience  of  the 
Germania,  of  Stettin,  published  in  1897,  sustains  the  Gotha  experience 
as  regards  the  value  of  medical  selection  in  reducing  the  mortality  from 
cancer  during  the  earlier  years  of  insurance.  Considering  the  two 
periods  of  duration  of  five  years  or  less  and  six  years  or  more,  it  appears 
that  the  actual  mortality  of  males  per  1,000  at  ages  31-40  was  0.21  and 
0.32,  respectively;  at  ages  41-50  it  was  0.67  and  1.14;  atages51-60,  it  was 
1.97  and  2.87;  and  at  ages  61  and  over,  4.63  and  6.64.  The  results  for 
females  are  about  the  same.  The  cancer  death  rate  for  males  was  1 .33  per 
1,000,  and  for  females,  1.90.  The  experience  covers  the  period  1857-94. 
It  may  be  stated  in  this  connection  that  for  women  only  the  death  rate 
from  cancer  during  the  period  1857-82  was  1.38  per  1,000,  whereas  for  the 
entire  period,  1857-94,  it  was  1.90.  There  had,  therefore,  been  a  not 
inconsiderable  increase  in  the  cancer  mortality  during  the  later  years, 
but  to  be  entirely  conclusive,  the  experience  should  have  been  extended 
to  insurance  durations  and  divisional  periods  of  life. 

Austro-Hungarian  Experience 

In  the  experience  of  the  Austrian  Phoenix,  the  proportionate  mor- 
tality from  cancer  has  increased  from  8.5  per  cent,  during  the  five  years 
ending  with  1906  to  10.4  per  cent,  during  the  five  years  ending  with  1912. 
In  the  experience  of  the  Riunione  Adriatica  di  Sicurta,  of  Trieste,  the  pro- 
portionate mortality  from  cancer  has  decreased  from  9.3  per  cent,  during 
the  seven  years  ending  with  1905  to  8.0  per  cent,  during  the  seven  years 
ending  with  1912.  In  the  experience  of  the  Alte  Leipziger,*  which  is  one  of 
the  largest  German  life  insurance  companies,  the  percentage  of  deaths 
from  cancer  has  increased  from  11.8  during  the  ten  years  ending  with 
1902  to  12.6  during  the  ten  years  ending  with  1912.  In  the  experience 
of  a  large  Hungarian  company,  the  Fonciere,  however,  the  proportionate 
mortality  from  cancer  has  declined  from  8.6  per  cent,  during  the 
five  years  ending  with  1905  to  8.0  per  cent,  during  the  five  years  ending 
with  1911.  In  the  experience  of  the  Assicurazioni  Generali,  the  largest 
Austrian  company,  the  proportionate  mortality  from  cancer  was  9.2 
per  cent,  during  1899-1905,  against  9.5  per  cent,  during  1906-12.  The 
experience  of  many  other  foreign  companies  could  be  quoted  to  sustain 
the  conclusion  that  in  most  cases  the  proportionate  mortality  from 
cancer  has  increased  during  recent  years  and  that,  in  any  event,  the 

*Leipziger  Lebensversicheruiigs-Gesellschaft,  Leipzig,  Germany. 

94 


CANCER  AND  LIFE  INSURANCE 

mortality  from  malignant  disease  is  of  much  greater  importance  to  life 
insurance  companies  than  has  generally  been  assumed  to  be  the  case. 
In  this  connection  it  is  necessary  to  take  into  account  the  probability 
that  medical  selection  during  the  last  twenty  or  thirty  years  has 
become  more  effective,  on  account  of  the  use  of  more  exact  and  con- 
clusive methods  of  medical  examination  for  insurance.  Better  selec- 
tion would,  of  course,  tend  to  reduce  the  mortality  from  diseases  more 
accurately  diagnosed,  particularly  during  the  early  years  of  policy 
duration.  It  is  true  that  the  rejection  rate  for  cancer  is  comparatively 
small,  but  the  implication  is  that  the  more  general  regard  to  abnormal 
or  subnormal  bodily  conditions  would  tend  to  eliminate  applicants  pre- 
disposed to  malignant  disease. 

American  Insurance  Experience,  1869-1900 
American  investigations  tend  to  confirm  this  point  of  view.  In  1903 
the  combined  experience  of  thirty -four  American  life  insurance  compa- 
nies was  published  by  the  Actuarial  Society  of  America.  It  was  brought 
out  with  reference  to  persons  who  had  a  family  history  of  cancer  that 
the  subsequent  experience  had  been  very  good  with  young  entrants, 
almost  equally  good  with  mature  entrants,  fairly  good  with  elderly 
entrants,  but  not  good  with  old  entrants,  although  the  actual  number 
of  the  latter  was  hardly  sufficient  for  a  final  adverse  conclusion.  On 
account  of  their  importance  the  facts  are  given  in  detail  in  the  table 
below,  showing  first,  the  actual  number  of  deaths  from  cancer,  second, 
the  number  of  deaths  expected  by  the  standard  table  adopted  and 
third,  the  ratio  of  actual  deaths  from  cancer  to  every  100  expected. 

Mortality  Experience  of  Applicants  with  a  Family  History  of  Cancer 
Thirty-four  American  Companies,  1869-1900 

Age  at  Entry  Actual  Deaths 

15-28 251 

29-42 1,089 

43-56 1,138 

57-70 352 

15-70 2,830  3,154.2  89.7 

It  is  regrettable  that  the  causes  of  death  were  not  given  in  this 
experience,  so  as  to  show  what  proportion  of  the  mortality  of  persons 
with  cancer  in  the  family  history  was  actually  from  cancer,  or,  if  not, 
from  w^hat  other  causes. 

Medico-Actuarial  Investigation,  Males* 
The  most  recent  collective  investigation  is  for  the  period  1885-1908. 
The  number  of  deaths  of  males  at  ages  15-29  was  4,566,  of  which  95 
were  from  cancer  and  other  malignant  tumors,  or  2.1  per  cent.  The 
cancer  mortality  rate  at  this  period  of  life  was  1.0  per  10,000  exposed 
to  risk.  At  ages  30-44  the  number  of  deaths  from  all  causes  was  7,886, 
of  which  377,  or  4.8  per  cent.,  were  from  cancer,  equivalent  to  a  rate  of 
3.2  per  10,000  exposed  to  risk.     At  ages  45  and  over  there  were  5,340 

*Medico-Actuarial  Mortality  Investigation,  New  York,  1913,  Vol.  ii,  p.  26,  et  seq. 

95 


Ratio  of  Actual 

Ixpected  Deaths 

to  Expected  Deaths 

333.7 

75.2 

1,313.6 

82.9 

1,186.3 

95.9 

320.6 

109.8 

TEE  MORTALITY  FROM  CANCER 

deaths  from  all  causes,  of  which  411  were  from  cancer,  or  7.7  per  cent., 
equivalent  to  14.4  per  10,000  exposed  to  risk.  The  proportionate  mortal- 
ity and  the  death  rate  from  cancer  and  other  malignant  tumors,  of  males, 
by  divisional  periods  of  life  and  duration  of  insurance,  are  given  in  the 
table  following: 

Experience  of  American  Insurance  Companies,  1885-1908 

(Medico- Actuarial  Investigation) 

Mortality  from  Cancer  and  Other  Malignant  Tumors 

^  STANDARD  LIVES,  MALES 


NtJMBER  OF  Policies 
Terminated  by  Death 

Percentage  of  Total 
Deaths 

Ratio  per  100,000 
Exposed  to  Risk 

Policy  Years 

Ages  at  Entry 
15-29         30-44        45-over 

Ages  at  Entry 
15-29        30-44       45-over 

Ages  at  Entry 
15-29        30-44       45-over 

1 

4           7         15 

4         25         42 
18         72       111 

.6       1.0       3.5 

.7       3.6       9.4 

1.4       3.9       8.9 

.2         .4         3.2 

2 

.3       1.9       12.0 

3-5 

.7       2.3       13.6 

6-10 

30       105       129 

2.5       4.7       7.8 

1.2       3.3       16.4 

11-24 

39       168       114 

4.1       7.0       7.3 

2.3       7.6       26.3 

Total 

95       377      411 

2.1       4.8       7.7 

1.0       3.2       14.4 

This  table  confirms  the  experience  of  the  Gotha  and  of  the  German 
Germania,  as  well  as  of  other  companies,  as  regards  the  value  of 
medical  selection  during  the  early  years  of  insurance,  but  the  value  of 
selection  is  distinctly  less  in  the  case  of  applicants  ages  45  and  over. 

Medico-Actuarial  Investigation,  Females 

The  same  experience  has  been  made  up  regarding  women  policyholders. 
At  ages  15-29  the  number  of  deaths  from  all  causes  among  insured 
women  was  3,696,  of  which  98,  or  2.7  per  cent.,  were  deaths  from  can- 
cer, or  1.4  per  10,000  exposed  to  risk.  At  ages  30-44  there  were  5,661 
deaths  from  all  causes,  of  which  668,  or  11.8  per  cent.,  were  deaths  from 
cancer,  equivalent  to  a  rate  of  7,3  per  10,000  exposed  to  risk.  At  ages 
45  and  over  there  were  4,917  deaths  from  all  causes,  of  which  654,  or 
13.3  per  cent.,  were  deaths  from  cancer,  or  24.3  per  10,000  exposed  to 
risk.  The  mortality  from  cancer  among  women,  by  divisional  periods 
of  life  and  duration  of  insurance,  is  shown  in  the  table  below: 

Experience  of  American  Insurance  Companies,  1885-1908 

(Medico- Actuarial  Investigation) 

Mortality  from  Cancer  and  Other  Malignant  Tumors 

STANDARD  LIVES,  FEMALES 


Number  of  Policies 
Terminated  by  Death 

Percentage  of 
Deaths 

Total 

Ratio  per  10,000 
Exposed  to  Risk 

Policy  Years 

Ages  at  Entry 
15-29         30-44        45-over 

Ages  at  Entry 
15-29        30-44       45-over 

Ages  at  Entry 
15-29        30-44       45-over 

1 

7        50        55 

5         52         64 

24       199       196 

1.1 

.9 
1.9 

6.4 

6.9 

11.0 

13.6 
15.8 
15.2 

.5       3.0       12.1 

2 

.5       4.0       18.1 

3-5 

1.0       6.6       23.5 

6-10 

26       240       212 

3.0 

15.6 

13.1 

1.6     10.3       28.8 

11-24 

36       127       127 

11.5 

16.3 

10.5 

7.2     15.4       40.7 

Total 

98       668       654 

2.7 

11.8 

13.3 

1.4       7.3       24.3 

96 


CANCER  AND  LIFE  INSURANCE 

This  table  also  confirms  the  previously  expressed  conclusion  as  re- 
gards the  value  of  medical  selection  in  reducing  the  mortality  from 
cancer  during  the  early  years  of  insurance,  but,  as  in  the  case  of  males, 
more  distinctly  with  regard  to  younger  applicants,  and  only  to  a  limited 
extent  for  applicants  ages  45  and  over.  The  American  insurance  ex- 
perience with  both  men  and  women  therefore  emphasizes  the  consider- 
able importance  of  cancer  as  a  cause  of  death  at  ages  30  and  over. 

Family  History  of  Cancer 

The  influence  of  a  family  record  of  cancer,  including  two  or  more 
cases,  was  investigated  by  the  Medico-Actuarial  Committee,  but  with 
negative  results.  The  number  of  expected  deaths  in  the  group  of 
applicants  having  a  family  record  of  two  or  more  cases  of  cancer  in  the 
family  history  was  87.3,  but  the  actual  number  of  deaths  experienced 
was  only  69,  or  79  per  cent,  of  the  expected.  Of  the  69  deaths  only  4 
were  from  cancer.  The  evidence  is,  therefore,  quite  conclusive  that  the 
earlier  apprehensions  regarding  a  family  history  of  cancer  were  not  justi- 
fied by  the  facts  of  subsequent  experience.  In  contrast,  it  may  be  stated 
that  the  ratio  of  actual  to  expected  deaths  in  cases  in  which  there  was 
a  family  record  of  two  or  more  cases  of  heart  disease  was  113  per  cent.* 

Effect  of  Build 
The  Medico-Actuarial  Investigation  considered  also  the  relation  of 
build  at  entry  to  causes  of  death,  with  distinction  of  three  divisional 
periods  of  life.  Dividing  the  male  applicants  into  three  classes;  that 
is,  first,  overweights,  or  those  whose  weight  at  entry  was  50  pounds  or 
more  above  normal  weight,  second,  those  who  were  of  normal  weight, 
and  third,  underweights,  or  those  who  weighed  25  pounds  or  more  below 
normal  weight,  the  experience  with  reference  to  cancer  was  as  follows : 
the  cancer  death  rate  per  10,000  exposed  to  risk  at  ages  15-29  was  0.9  for 
overweights  and  0.8  for  underweights,  at  ages  30-44  it  was  3.7  for  over- 
weights and  2.4  for  underweights,  and  at  ages  45  and  over  15.6  for  over- 
weights and  12.0  for  underweights.  The  experience,  therefore,  supports 
the  view  occasionally  expressed  by  writers  on  the  subject  of  cancer 
occurrence  that  the  disease  is  more  common  among  persons  of  over- 
weight than  among  underweights,  and  by  inference,  among  the 
well-to-do  and  overnourished  than  among  the  less  prosperous  element. 
The  medico-actuarial  evidence  is  of  exceptional  value,  in  that  it  con- 
firms this  conclusion  for  three  periods  of  life  on  the  basis  of  what  may 
safely  be  considered  to  have  been  a  sufficient  numerical  exposure,  f 

Effect  of  Conjugal  Condition 

Considering  the  importance  of  this  conclusion  it  is  a  matter  of  regret 
that  a  corresponding  investigation  into  the  mortality  of  overweights 
and  underweights,  by  causes  of  death,  should  not  have  been  made  with 

*Medico-ActuariaI  Mortality  Investigation,  New  York,  1913,  Vol.  iv.  Part  i,  p.  24. 

fin  the  third  volume  of  the  treatise  on  cancer  by  J.  Wolff  (p.  37)  there  is  a  brief  discussion  of  the  probable 
correlation  of  height  to  cancer  frequency,  the  view  being  advanced  that  cancer  is  more  common  among  tall 
persons  than  among  those  of  short  stature.  This  phase  of  the  cancer  problem  has  not  been  sufficiently  inquired 
into,  which  holds  true  also  of  the  anthropometric  aspects  of  the  cancer  problem  in  general.  It,  however,  re- 
quires to  be  kept  in  mind  that  there  is  an  important  correlation  of  height  to  weight  and  that  persons  of  short 
stature  are  as  a  rule  more  likely  to  be  overweight  than  persons  above  the  normal  average  height. 

97 


THE  MORTALITY  FROM  CANCER 

regard  to  women,  but  some  exceedingly  interesting  data  are  furnished 
by  the  investigation  of  deaths  according  to  conjugal  condition,  briefly  set 
forth  in  the  following  table: 

Experience  of  American  Insurance  Companies  1885-1908 

(Medico-Actuarial  Investigation) 

Mortality  from  Cancer  and  Other  Malignant  Tumors,  according  to  Conjugal 

Condition  (Rate  per  10,000  Exposed  to  Risk) 

Ages  at  Entry 
15-29  30-44  45-over 

Spinsters 0.9  5.2  15.4 

Married  (beneficiary,  husband) 1.5  7.1  20.9 

Married  (beneficiary  other  than  husband) .  2.9                 8.0              '  26.4 
Widowed  and  divorced 1.7 10^3 25.9 

According  to  this  table  the  mortality  from  cancer  and  other  malig- 
nant tumors  was  distinctly  higher  at  all  periods  of  life  among  married 
and  widowed  women  than  among  spinsters.  The  married  women,  for 
insurance  purposes,  have  been  divided  into  two  classes:  the  first  being 
those  who  had  made  their  husband  the  beneficiary  in  the  event  of 
their  death  and  the  second  being  those  whose  beneficiary  was  other  than 
their  husband.  The  latter  class  throughout  show  a  distinctly  higher 
mortality  from  cancer  and  other  malignant  disease.  The  evidence  as 
regards  a  lesser  liability  of  spinsters  to  cancer  (all  forms)  would  seem  to 
be  conclusive,  since  the  comparative  rates  represent  an  apparently 
sufficient  exposure  for  each  of  the  three  divisional  periods  of  life. 

These  results  of  the  medico-actuarial  investigation  are  in  conformity  to 
a  special  analysis  of  the  data  for  the  District  of  Columbia,  which,  however, 
have  not  been  completely  standardized  for  variations  in  age  distribu- 
tion. For  males  the  cancer  death  rate  for  the  married  was  108.8  per 
100,000  of  population,  ages  15  and  over,  against  56.6  for  the  single,  and 
for  females  the  rates  were  122.7  for  the  married  and  59.9  for  the  single. 
With  special  reference  to  cancer  of  the  generative  organs,  the  rates  were 
41.4  for  the  married  and  11.0  for  the  single,  and  for  cancer  of  the  breast 
the  rates  were  22.0  for  the  married  and  17.8  for  the  single.  When 
standardized  for  age  these  differences  would,  of  course,  be  more  pro- 
nounced.    These  rates  refer  to  the  white  population  only. 

Cancer  of  the  Breast  and  Generative  Organs  among  Single 
and  Married  Women* 

Some  exceptionally  valuable  observations  on  the  relative  frequency  of 
cancer  of  the  breast  and  of  the  generative  organs  among  the  single  and 
the  married  have  recently  been  published  in  the  76th  Annual  Report  of 
the  Registrar-General  of  Births,  Deaths  and  Marriages  in  England  and 
Wales  (London,  1915).  This  investigation  is  the  first  of  its  kind,  but 
the  conclusions  are  extremely  important.  Deaths  from  cancer  of  the 
ovaries,  the  uterus  and  the  breast  are  separately  considered,  according  to 
conj\igal  condition,  with  a  due  regard  to  the  number  of  single  and 
married  women  living  at  specific  periods  of  life.  The  usual  error  arising 
out  of  an  unequal  age  distribution  is  therefore  avoided.     As  observed  in 

*0n  account  of  the  preceding  discussion  with  reference  to  insurance,  this  section  is  here  included,  although 
derived  entirely  from  the  78th  Annual  Report  of  the  Registrar-General  for  England  and  Wales,  London,  1916. 

98 


CANCER  AND  LIFE  INSURANCE 

the  report,  the  effect  of  marital  condition  upon  the  mortality  from  cancer 
of  the  generative  organs  and  the  breast  "is  seen  to  be  very  considerable." 
During  the  three  years  1911-13  (which  were  combined  to  secure  a  suffi- 
cient basis  of  facts  for  the  purpose  and  to  eUminate  chance  fluctuations), 
"the  mortality  of  single  women  from  cancer  of  the  ovary  has  been  twice 
as  great  as  that  of  the  married,  due  allowance  being  made  for  the  different 
age-distributions  of  these  two  sections  of  the  population.  The  mortality 
of  the  unmarried  from  cancer  of  the  breast  similarly  exceeded  that  of  the 
married  by  45  per  cent."  But,  in  contrast,  "from  cancer  of  the  uterus 
the  married  suffered  from  a  mortaUty  73  per  cent,  greater  than  the 
single."  The  term  married  for  the  present  purpose  includes  the  widowed 
and  divorced. 

It  is  pointed  out  that  these  results  are  at  variance  with  the  usual  con- 
clusions deduced  from  the  available  material  by  surgical  authorities,  on 
account  of  the  fact  that  proper  correction  is  not  made  for  the  considerable 
variations  in  the  age  distribution  of  the  single  and  married,  and  the  equally 
important  variations  in  the  age  incidence  of  the  three  forms  of  cancer 
considered,  that  is,  of  the  ovary,  the  uterus  and  the  breast.  Extreme 
care  was  used  in  standardizing  the  rates  for  the  married  and  single  by 
divisional  periods  of  Hfe,  but  the  methods  employed  are  too  technical  to 
require  consideration  in  a  work  of  this  kind.  They  are  fully  explained 
in  the  report,  which  is  conveniently  available  for  general  use.  The  term 
cancer  as  employed  for  the  present  purpose  includes  sarcoma,  but  in  the 
statistical  tables  the  facts  are  given  separately.  The  general  results  of  this 
important  investigation  are  briefly  summarized  as  follows : 

During  the  period  of  active  sexual  life  there  is  practical  equality  of 
mortality  from  breast  cancer  among  the  single  and  the  married,  but  after 
age  45  the  excess  among  the  single  becomes  very  pronounced.  The 
great  excess  of  mortahty  from  cancer  of  the  uterus  among  the  married 
is  in  accordance  with  the  generally  accepted  views  upon  this  subject. 
It  is  regrettable  that  it  should  not  have  been  feasible  to  distinguish 
cancer  of  the  body  of  the  uterus  from  cancer  of  the  cervix.  In  course 
of  time  it  is  to  be  hoped  that  all  death  certificates  will  be  amplified  and 
made  to  contain  these  as  well  as  some  other  necessary  additional  facts. 
It  is  generally  held  that  cancer  of  the  body  of  the  uterus  is  not  more 
common  in  mothers  than  in  other  women,  or  more  frequent  in  women 
who  have  not  given  birth.  Cancer  of  the  cervix  is  thought  to  result 
from  past  injury  in  labor,  but  few  of  the  certificates  give  the  necessary 
information,  so  that  for  the  time  being  no  conclusive  answer  can  be  made 
to  this  important  question.  It  is  shown  by  the  report  that  "in  the  case 
of  uterine  cancer  the  difference  in  mortality"between  the  married  and  the 
single  is  much  greater  before  than  after  50,  and  that  the  difference 
practically  disappears  after  75.  In  other  words,  the  difference  is  most 
pronounced  in  the  case  of  uterine  cancer  and  least  so  in  cancer  of  the 
breast,  but  "in  each  case  it  is  the  mortality  of  the  single  which  increases 
relatively  to  that  of  the  married  with  the  advance  of  age." 

The  importance  of  treating  sarcoma  separately  is  emphasized  in  the 
case  of  cancer  of  the  ovary,  where  sarcoma  is  relatively  more  frequent 
than  in  the  uterus  or  breast.  In  this  case,  it  is  pointed  out  that  "the 
excess  of  mortahty  amongst  the  single  is  very  great  at  all  ages  after  35, 

90 


TEE  MORTALITY  FROM  CANCER 

at  which  the  number  of  deaths  is  sufficient  to  attach  significance  to  the 
figures.  The  effect  of  marital  condition  upon  [cancer]  mortahty  would 
seem  to  be  at  its  maximum  in  the  case  of  the  ovary,  but  has  not  perhaps 
attracted  so  much  attention  as  in  the  case  of  the  uterus  or  breast — 
presumably  on  account  of  the  lesser  frequency  of  the  condition." 

The  rate  of  increase  in  mortahty  from  cancer  of  the  various  organs 
considered  is  shown  to  differ  quite  considerably.  After  pointing  out 
that  "in  both  sexes  the  most  rapid  rates  of  increase  are  furnished  by 
cancer  of  the  alimentary  tract,  especially  the  intestine  and  stomach," 
it  is  observed  that  "disease  of  the  female  breast  also  claims  a  rapidly 
increasing  number  of  ^actims,  while  mortality  from  uterine  cancer  is 
diminishing."  This  curious  but  very  interesting  result  is  in  part  at- 
tributed to  the  diminishing  birth  rate,  and  it  is  said  in  this  connection 
that  "It  would  appear  that  child-bearing  increases  the  risk  of  uterine  and 
diminishes  that  of  mammary  cancer,  and  it  is  therefore  only  to  be 
expected  that  the  present  decrease  in  fertility  should  be  accompanied  by 
an  increase  in  mammary  but  not  in  uterine  cancer." 

Age  and  Conjugal  Condition  in  Cancer  of  the  Generative  Organs 

The  details  of  the  recent  Enghsh  experience  are  given  in  Tables  15a  to 
15c  of  Appendix  G.  The  data  have  been  rearranged  in  a  convenient 
form  for  the  purpose  of  facihtating  the  comparison  of  the  unmarried 
and  the  married.  The  excess  in  the  cancer  death  rate  of  either  group 
is  indicated  and  the  variations  in  the  rate  are  shown  in  the  manner  of  the 
rate  for  ages  25-29  being  taken  as  100.  Cancer  of  the  ovary,  for  illustra- 
tion, is  sho\\Ti  to  be  excessive  among  the  unmarried  at  all  ages  excepting 
80-84,  when  the  actual  numbers,  however,  are  too  small  for  a  safe 
generahzation.  The  maximum  excess  in  the  rate  for  the  unmarried 
occurs  at  ages  55-59.  Assuming  the  rate  at  ages  25-29  as  100,  the  rate  at 
ages  55-59  is  equivalent  to  2,422,  diminishing  gradually  towards  the  end 
of  life,  with  the  exception  of  ages  75-79,  which  must  be  considered  ac- 
cidental. The  corresponding  rate  for  the  married  reaches  its  greatest  rela- 
tive significance  at  ages  65-69,  declining  subsequentlj^  to  the  end  of  life. 

In  marked  contrast  are  the  results  for  cancer  of  the  breast.  Here  it  is 
shown  that  the  rate  is  excessive  for  the  unmarried,  with  the  exception  of 
ages  under  35,  when,  however,  the  actual  rates  are  of  "relatively  small 
importance.  Assuming  the  rate  at  ages  25-29  as  100,  there  is  a  progres- 
sive increase  in  the  rate  to  the  end  of  life;  the  same  is  true  for  the  married, 
but  the  rise  in  the  rate  is  slower  and  of  less  actual  significance. 

The  most  marked  contrast,  however,  occurs  in  the  case  of  cancer  of  the 
uterus.  There  is  an  excess  in  the  death  rate  for  the  married  of  all  ages 
excepting  80-84,  which  is  probably  accidental.  Assuming  the  rate  at 
ages  25-29  as  100,  there  is  a  rapid  rise  towards  50-54,  after  which  the 
rate  remains  practically  stationary  to  about  the  age  75,  when  there  is  a 
further  rise  and  a  subsequent  decline  for  the  unmarried,  but  the  changes 
are  possibly  due,  in  part  at  least,  to  the  smallness  of  the  numbers  con- 
sidered at  the  extreme  end  of  hfe.  It  would  seem. safe  to  conclude  that 
the  relative  mortality  from  cancer  of  the  uterus  remains  much  the  same 
during  the  period  follomng  the  cessation  of  active  sexual  life  except  at 
the  extreme  ages. 

100 


CANCER  AND  LIFE  INSURANCE 


These  results  are  exceptionally  interesting  and  of  much  practical 
usefulness.  They  indicate  with  unusual  clearness  the  value  of  specialized 
statistical  research  into  the  more  involved  aspects  of  the  cancer  problem. 
It  is  to  be  anticipated  that  corresponding  statistics  will,  in  course  of  time, 
be  published  for  at  least  the  registration  states  of  the  United  States, 
by  the  Division  of  Vital  Statistics  of  the  Census  Office. 

Mortality  Experience  of  The  Prudential  Insurance  Company  of  America 

Some  interesting  facts  regarding  cancer  as  disclosed  by  the  experience 
of  a  large  and  representative  life  insurance  company  were  first  exhibited 
by  The  Prudential  in  connection  with  an  exhibit  made  at  The  Louisiana 
Purchase  Exposition,  in  1904.  The  information  has  been  brought  down 
to  date,  and  the  results  seem  to  prove  that  the  proportionate  mor- 
tality from  cancer  is  distinctly  less  among  Industrial  risks,  repre- 
sentative of  the  wage-earning  element,  and  regardless  of  a  more  rigid 
medical  examination,  distinctly  higher  among  Ordinary  risks,  repre- 
sentative of  the  more  prosperous  and  well-to-do.  Considering  only 
the  age  period  40-59,  it  appears  that  for  males  the  proportionate 
mortality  from  cancer  in  the  Company's  Ordinary  experience  was  6.9 
per  cent.,  against  5.4  per  cent,  in  the  Industrial  experience.  For  females 
the  corresponding  proportions  were  18.7  per  cent,  in  the  Ordinary 
experience  and  14.9  per  cent,  in  the  Industrial.  Throughout,  the 
proportionate  mortality  from  cancer  was  higher  among  insured 
women  than  among  insured  men.  Selecting,  for  illustration,  the  age 
period  50-54,  it  appears  that  in  the  Industrial  experience  of  The  Pru- 
dential the  proportion  of  deaths  from  cancer  at  this  period  of  life  was 
6.3  per  cent,  for  males,  against  16.6  per  cent,  for  females.  In  the 
Ordinary  experience  the  corresponding  proportions  were  8.4  per  cent,  for 
males  and  19.0  per  cent,  for  females.  It  is  quite  probable  that  the 
value  of  medical  selection,  with  particular  reference  to  cancer,  is 
less  in  the  case  of  insured  women  than  in  the  case  of  insured  men;  but 
in  view  of  the  facts  disclosed  by  the  medico-actuarial  investigation 
that  there  is  a  distinct  value  in  the  medical  selection  with  reference  to 
cancer  as  shown  by  the  reduced  mortality  from  this  disease  during  the 
early  years  of  policy  duration,  it  would  seem  safe  to  conclude  that  the 
proportionate  mortality  from  cancer  is  higher  among  the  prosperous  and 
well-to-do  than  among  the  wage-earning  element,  including  the  less 
prosperous  and  the  poor. 

The  proportionate  mortality  from  cancer  in  the  Industrial  and  Or- 
dinary experience  of  The  Prudential  is  briefly  suminarized  below: 

Prudential  Ordinary  Mortality  Experience 
Mortality  from  Cancer,  by  Age  and  Sex,  1886-1913 


Deaths 
Ages  from 

All  Causes 

Under  45 19,514 

45  and  over 13,905 

Total 33,419 


MALES 

Deaths 

from 

Cancer 

479 
1,184 


1,663 


Per 

Cent. 

2.5 

8.5 

5.0 


Deaths 

from 

All  Causes 

4,912 
2,607 


FEMALES 

Deaths 

from  ' 

Cancer 


7,519 


300 
464 


764 


Per 

Cent. 

6.1 

17.8 

10.2 


101 


TEE  MORTALITY  FROM  CANCER 


Prudential  Industrial  Mortality  Experience,  White 
Mortality  from  Cancer,  by  Age  and  Sex,  1909-1913 


Ages 

Under  15. 
15-44.... 


45  and  over . 


Deaths 

from 

All  Causes 

35,822 
64,296 


MALES 
Deaths 

from 
Cancer 

123 

846 


95,015        6,243 


Total 195,133 


7,212 


Per 
Cent. 

0.3 
1.3 
6.6 

3.7 


FEMALES 

Deaths  Deaths 

from  from 

All  Causes  Cancer 

30,840  85 

60,770  2,917 

102,750  11,993 


194,360      14,995 


Per 

Cent. 

0.3 

4.8 
11.7 

7.7 


The  table  following  is  a  brief  summary  of  the  Industrial  experience  of 
The  Prudential  for  the  years  1909-12,  showing  the  proportionate  mortality 
from  cancer  and  sarcoma  by  divisional  periods  of  life,  according  to  sex. 

Prudential  Industrial  Mortality  Experience,  White 
Mortality  from  Sarcoma  and  Other  Forms  of  Cancer,  by  Age  and  Sex 

1909-1912 


MALES 

FEMALES 

Ages 
Under  15 

Sarc 

No.  of 
Deaths 

44 

OMA 

Per 

Cent. 

15.0 
35.0 
50.0 

Other  Forms 
OF  Cancer 
No.  of         Per 
Deaths       Cent. 

39         0.8 

533       10.3 

4,589       88.9 

Sarc 

No.  of 
Deaths 

26 
103 
194 

323 

OMA 

Per 

Cent. 

8.0 
31.9 
60.1 

Other  Forms 
OP  Cancer 
No.  of         Per 
Deaths       Cent. 

39        0.4 

15-44 

45  and  over 

103 
147 

294 

2,114       19.0 
8,985       80.6 

Total 

100.0 

5,161     100.0 

100.0 

11,138     100.0 

In  amplification  of  the  preceding  dicussion  two  additional  tables 
are  included  exhibiting  the  proportionate  mortality  from  sarcoma 
and  other  forms  of  cancer  for  males  and  females  in  The  Prudential 
experience,  1909-12.  No  corresponding  information  regarding  the  age 
incidence  of  sarcoma  and  its  bearing  upon  the  general  mortality  by 
divisional  periods  of  life  is  available.  It  is  conclusively  shown  that 
sarcoma  is  of  much  greater  importance  during  early  life  than  other  forms 
of  cancer,  but  the  proportion  to  the  mortality  from  all  causes  remains 
about  the  same,  above  age  15,  and  for  both  sexes,  in  marked  contrast 
to  the  rapid  increase  in  the  proportion  of  deaths  from  other  forms  of 
cancer  among  males  and  females,  but  naturally  very  much  more  so 
among  the  latter  than  among  the  former  at  ages  45  and  over.  Of 
course,  it  is  regrettable  that  these  returns  could  not  have  been  given 
with  reference  to  the  exposed  to  risk;  but  they  suflSciently  emphasize  the 
practical  importance  of  statistical  research  in  this  direction  with 
reference  to  the  mortality  from  cancer  among  the  general  population. 

Prudential  Industrial  Mortality  Experience,  White 
Proportionate  Mortality  of  Sarcoma  and  Cancer  to  All  Causes,  by  Age,  Males 

1909-1912 


Ages 


Deaths 

from 

All  Causes 


Under  15 28,024 

15-44 50,032 

46  and  over 73,490 


Total 151,546 


Sarcoma 


No.  of 

Deaths 


Per 

Cent. 


44  0.16 

103  0.21 

147  0.20 

294  0.19 


Other  Forms 
OP  Cancer 

No.  of  Per 

Deaths        Cent. 


39 
533 

4,589 


0.14 
1.07 
6.24 


5,161       3.41 


102 


CANCER  AND  LIFE  INSURANCE 

Prudential  Industrial  Mortality  Experience,  White 
Proportionate  Mortality  of  Sarcoma  and  Cancer  to  All  Causes,  by  Age,  Females 

1909-1912 


Ages 


Deaths 

from 

All  Causes 


Under  15 24,195 

15-44 47,324 

45  and  over 79,622 


Total 151,141 


Sabcoma 


No.  of 
Deaths 


Per 

Cent. 


26  0.11 
103  0.22 
194        0.24 


323 


0.21 


Other  Forms 
OP  Cancer 


No.  of 
Deaths 

39 
2,114 
8,985 


Per 
Cent. 

0.16 

0.45 

11.28 


11,138        7.37 


All  the  necessary  details  of  this  experience,  by  organs  and  parts,  with 
data  regarding  age  and  sex,  are  given  in  Tables  4  to  7,  Appendix  D. 

Cancer  as  a  Life  Insurance  Problem 
The  business  of  life  insurance  within  the  last  half-century  has 
attained  to  enormous  proportions.  The  number  of  policies  in  force 
with  legal-reserve  life  insurance  companies  of  the  United  States  on 
December  31,  1914,  was  40,204,119,  of  which  31,159,038  were  on  the 
Industrial  plan.  The  number  of  new  policies  issued  during  1914  was 
8,091,175,  of  which  1,398,942  were  Ordinary  and  6,692,233  were  Indus- 
trial contracts.  All  of  the  Ordinary  policies  and  a  considerable  pro- 
portion of  the  Industrial  policies  are  issued  upon  a  medical  examination, 
which  has  primarily  for  its  object  the  elimination  of  risks  likely  to 
terminate  by  death  during  the  early  years  of  policy  duration.  Medical 
selection  is  successful  in  proportion  to  the  attained  reduction  of  mortality 
during  the  early  years  of  policy  duration,  and  this  is  especially  true  with 
regard  to  chronic  diseases.  The  value  of  medical  selection,  however, 
is  both  general  and  special,  and  the  benefit  of  such  selection,  with 
regard  to  cancer,  has  been  clearly  established  by  the  several  investiga- 
tions to  which  reference  has  been  made  at  some  length.  Cancer,  by 
its  nature,  is  representative  of  a  not  inconsiderable  group  of  diseases 
which  are  extremely  difficult  of  early  diagnosis  and  particularly  so 
for  life  insurance  purposes.  It  is  for  this  reason  that  life  insurance 
companies  are  directly  interested  in  the  nation-wide  effort  to  control 
a  disease,  which  has  not  inappropriately  been  described  as  a  scourge, 
in  educational  efforts  along  lines  of  prevention  which  have  the  approval 
of  the  foremost  authorities  in  medical  and  surgical  science.* 

*For  additional  observations  on  cancer  as  a  life  insurance  problem,  see  my  address  on  "The  Educational 
Value  of  Cancer  Statistics  to  Insurance  Companies,  the  Public  and  the  Medical  Profession,"  Transactions  of 
the  Clinical  Congress  of  Surgeons  of  North  America,  1913.  See  also  observations  on  cancer  in  the  "Text 
Book  of  Legal  Medicine,"  by  Peterson  and  Haines,  Philadelphia,  1903,  Vol.  i,  pp.  454-455. 


103 


CHAPTER  VI 

THE  GEOGRAPHICAL  INCIDENCE  OF  CANCER 
THROUGHOUT  THE  WORLD 

Problems  of  Geographical  Pathology — Recent  International  Statistics — Cancer  Frequency 
throughout  the  World — Distribution  of  Cancer  in  the  United  States — Local  Varia- 
tions in  Cancer  Occurrence — Mortality  from  Biliary  Calculi  and  Tumors  of  the 
Uterus  and  Ovaries — ^Increase  in  Cancer,  by  Organs  and  Parts,  and  by  Age  and  Sex — 
Mortality  by  Season — Statistics  of  the  New  York  State  Pathological  Institute — 
Previous  Duration  of  Malignant  Disease — Family  History  and  Heredity — Primary 
Seat  of  Growth,  Probable  Causes,  and  Personal  History — Geographical  Pathology 
of  Cancer  by  Specified  Organs  and  Parts,  throughout  the  World. 

The  ascertainment  with  approximate  scientific  accuracy  of  the  geo- 
graphical incidence  of  cancer  throughout  the  world  is  necessarily  a 
difficult  and  laborious  undertaking.  In  a  large  measure  such  an  effort 
at  the  present  time  must  necessarily  prove  productive  of  incomplete  and 
unsatisfactory  results  for  a  large  portion  of  the  world's  surface  for  which 
trustworthy  vital  statistics  are  not  available.  The  classical  attempt 
on  the  part  of  Haviland,  in  cooperation  with  William  Farr,  in  1875,  jto 
establish  with  scientific  exactitude  the  geographical  distribution  of  can- 
cer in  females  in  England  and  Wales  suggests  the  ideal  method  of  statis- 
tical research,  which  has  only  been  attained  for  comparatively  small 
areas  of  countries  with  accurate  returns  of  the  causes  of  death. 

Prinzing  in  1908,  published  the  results  of  a  strictly  scientific  study  of 
cancer  frequency  in  certain  administrative  subdivisions  of  WUrttemberg, 
following  an  earlier  study  of  a  similarly  localized  excessive  cancer 
mortality  in  certain  portions  of  South  Germany  and  adjacent  parts  of 
Austria  and  Switzerland.*  Hirsch  was  one  of  the  first  to  report  upon 
the  geographical  and  historical  pathology  of  cancer,  observing  at  the 
time 

As  comprehensive  a  knowledge  as  possible  of  the  geographical  distribution  of  cancer  of 
the  breast  and  womb  is  much  to  be  wished,  for  the  sake  of  the  light  that  it  might  throw 
upon  the  etiology  of  that  most  disastrous  affliction  of  the  female  sex.  But  every 
attempted  research  of  geographical  pathology  in  that  direction  is  foiled  at  the  outset  by 
the  want  of  trustworthy  statistics  of  mortality. 

This  was  written  about  1885,  when  most  of  the  cancer  mortality 
returns  failed  to  distinguish  the  organs  and  parts  of  the  body  affected 
by  cancerous  growth.  In  Hirsch's  work  there  are  many  useful  ob- 
servations, however,  which  may  still  be  read  to  advantage,  f  He  re- 
marks inter  alia  that 

The  impracticable  state  of  our  knowledge  when  an  inquiry  is  attempted  for  the  whole 
globe  comes  out  conspicuously,  not  so  much  in  the  want  of  information  as  to  the  exist- 
ence and  prevalence  of  cancer  in  many  parts  of  the  world,  but  in  the  fact  that  in  all  but 
a  few  instances  there  is  no  attention  paid  to  the  frequency  of  the  disease  in  the  female 
sexual  organs,  or  only  such  terms  used  as  "common"  or  "rare,"  which  are  of  equivocal 
value. 

Hirsch  refers  to  the  conclusion  of  Haviland  that  cancer  in  the  female 

*Dr.  Fr.  Prinzing:  Das  Gebiet  hoher  Krebssterblichkeit  in  siidlichen  Deutschland  und  in  den  angrenzendeu 
Teilen  Oesterreichs  und  der  Schweiz.     Zeitschrif  t  fUr  Krebsforschung.     5.  Band.  Berlin,  1907. 

tHirsch,  "Handbook  of  Geographical  and  Historical  Pathology,"  London,  1886,  Vol.  iii,  p.  50. 

104 


CANCER  THROUGHOUT  THE  WORLD 

sex  is  rarest  in  England  on  hard  rock  and  in  high-lying  places  and 
commonest  on  the  wet  soil  of  river  basins  subject  to  inundations;  but 
he  questions  the  trustworthiness  of  the  material  used,  for  he  points  out 
that  the  generalization  is  opposed  by  the  fact  that  in  Norway  cancer 
occurs  mostly  in  the  mountainous  districts  and  at  considerable  eleva- 
tions, to  some  extent,  along  the  shores  of  the  fiords,  but  least 
of  all  on  the  open  coast.  And  he  further  observes  that  in  Mexico  the 
population  living  on  the  high  table-land  is  more  subject  to  cancer  than 
the  people  living  on  the  low  plains.  Curiously  enough,  in  a  brief  dis- 
cussion of  the  question  of  cancer  increase,  Hirsch  makes  use  of  the 
statistics  of  Frankfurt  a/M.,  "a  city  which  has  long  been  noted  for  the 
completeness  of  its  population  statistics,"  where  he  claims  "there  has 
not  only  been  no  increase  during  the  last  twenty-one  years  in  the  fre- 
quency of  those  forms  of  cancer  which  can  be  most  accurately  diagnosed 
during  life  or  after  death^  namely,  mammary  and  uterine  cancer,  but 
indeed  a  considerable  decrease  when  allowance  is  made  for  the  fact  that 
the  population  has  almost  doubled  during  that  period."  These  con- 
clusions, however,  are  not  substantiated  by  the  facts.* 

Davidson  in  1892  published  the  results  of  an  inquiry  into  the  geo- 
graphical distribution  of  infective  and  climatic  diseases,  in  his  "Geo- 
graphical Pathology,"  in  which  he  gave  extended  consideration  to  the 
frequency  of  cancer  in  different  countries  of  the  world.  The  work  is  of 
considerable  interest  and  a  useful  source  of  reference;  but  the  results 
were  not  reduced  to  a  uniform  basis  of  comparison.  In  the  main,  how- 
ever, they  reflect  the  prevailing  medical  opinion  of  the  period. 

Clemow  in  1903  published  a  treatise  in  the  Cambridge  Geographical 
Series  on  "The  Geography  of  Disease,"  in  which  cancer  is  considered 
briefly  and  without  regard  to  the  need  of  uniform  and  strictly  comparable 
statistics.  The  discussion,  however,  is  otherwise  of  considerable  prac- 
tical value  and  in  the  main  confirms  the  conclusions  derived  from  other 
sources.  Clemow  emphasizes  the  local  incidence  of  the  disease  in  cir- 
cumscribed areas  of  certain  countries,  and  he  adds  many  useful  ob- 
servations with  regard  to  cancer  frequency  among  native  races,  largely 
based  upon  the  use  of  material  not  otherwise  so  conveniently  accessible 
to  the  student  of  the  subject.f 

In  none  of  these  cancer  surveys  for  the  world  as  a  whole  has  an  attempt 
been  made  to  consolidate  the  available  material  on  the  basis  of  standard- 
ized population  estimates  and  fairly  uniform  methods  of  classification. 
W.  R.  Williams,  in  his  "Natural  History  of  Cancer,"  has  enlarged  upon 
the  geographical  aspects  of  the  cancer  problem;  but  his  observations 
also  are  impaired  in  value  by  the  non-availability  of  uniform  data  for  at 
least  the  principal  countries  of  the  world  and  for  periods  of  observation 
at  least  fairly  coincident  in  point  of  time. 

*A  further  attempt  to  substantiate  the  Frankfurt  a/M.  data  by  means  of  special  statistical  research  brought 
down  to  date  has  been  made  by  Prof.  Walter  F.  Willcox,  in  an  address  on  "The  Alleged  Increase  in  Cancer," 
read  at  the  meeting  of  the  American  Public  Health  Association,  December  2, 191-t.  The  address  has  not  yet  been 
printed,  and  the  data  are  therefore  not  available  in  detail;  but  apparently  the  same  erroneous  classification  of 
internal  and  external  cancers  adopted  by  King  and  Newsholme  was  made  use  of,  instead  of  the  classification 
suggested  by  Bashford  or  the  method  of  analysis  by  specific  organs  and  parts  elsewhere  made  use  of  in  this  work. 

tin  1902  Dr.  Irving  Phillips  Lyon, M.D., of  the  New  YorkPathological  Institute  madeabriefinvestigation 
of  the  geographical  distribution  of  Cancer  in  Brookfield,  Madison  Coimty,  N.  Y.,  published  in  the  Annual 
Report  of  the  New  York  State  Board  of  Health,  1902,  as  an  introduction  to  a  more  comprehensive  investigation, 
which,  however,  has  not  thus  far  been  made.     (See  my  "Menace  of  Cancer,"  page  31.) 

105 


TEE  MORTALITY  FROM  CANCER 
Recent  International  Statistics 

The  purpose  of  the  present  work  is  to  meet  this  requirement,  at  least 
in  a  preUminary  form,  as  a  trustworthy  basis  for  a  more  comprehensive 
study  of  cancer  as  a  problem  in  medical  statistics.  Efforts  have  been 
made  in  the  past  to  bring  together  the  cancer  mortality  statistics  for 
different  countries  and  cities,  particularly  in  the  special  reports  of  the 
National  Department  of  Statistics  of  France  and  in  the  Memorial  Volume 
of  the  Department  of  Statistics  of  Amsterdam,  prepared  for  the  Dresden 
International  Exposition  of  Hygiene.  These  reports,  however,  give  only 
the  general  mortality  from  cancer,  that  is,  without  reference  to  sex,  age 
or  organs  and  parts  of  the  body  affected.  There  is  a  further  limitation 
in  the  use  of  these  data,  in  that  they  are  in  some  respects  wanting  in 
accuracy,  apparently,  not  having  in  all  cases  been  derived  from  trust- 
worthy official  sources  or  been  carefully  compared  with  the  data  pub- 
lished under  official  authority.  In  the  present  case  the  statistics  are, 
unless  otherwise  stated,  invariably  derived  by  actual  transcript  from 
official  reports  or  they  have  been  secured  by  direct  correspondence, 
through  the  courtesy  of  the  officials  in  charge  of  the  registration  of 
deaths.  The  populations  have  been  estimated  for  intercensal  years  as 
far  as  consistent  with  the  known  facts  of  population  progress  and  in  a 
uniform  manner;  or  when  this  has  not  been  possible,  a  conservative  esti- 
mate has  been  arrived  at  on  the  basis  of  all  the  available  information. 
An  effort  has  been  made  to  provide  at  least  some  statistical  returns 
for  every  important  country  of  the  world,  or  at  any  rate  for  the  more 
important  cities  typical  of  a  region,  as  an  illustration  of  the  local  inci- 
dence of  cancer  as  possibly  determined  by  local  conditions. 

Cancer  Throughout  the  World 

More  or  less  trustworthy  mortality  statistics  regarding  cancer  are 
available  for  a  population  of  about  450,000,000,  which  is  approximately 
26  per  cent,  of  the  entire  population  of  the  world,  estimated  for  the  year 
1911.  The  general  cancer  mortality  by  continents,  as  determined  on 
the  basis  of  the  returns  for  the  period  1908-12,  was  as  follows: 

Mortality  from  Cancer 
Registration  Countries  of  the  World,  1908-1912* 

Rate  per 
„     ,.       ^  T>       1  *•  No.  of  Deaths  .100,000 

Continent  Population  from  Cancer  Population 

Africa 9,041,866  3,018  33.4 

America 382,549,311  251,438  65.7 

Asia 272,814,962  148,447  54.4 

Australasia..       27,886,740  20,345  73.0 

Europe 1,431,996,861  1,096,716  76.6 

Total 2,124,289,740  1,519,964  71.6 

For  the  period  under  consideration  there  was  a  total  population  under 
review  of  2,124,289,740  and  of  this  number  1,519,964  died  from  cancer 
during  the  five-year  period,  a  mortality  equivalent  to  71.6  per  100,000 

*The  data  used  in  this  table  are,  with  a  few  exceptions,  for  the  period  1908-12  For  information  in  detail, 
see  Tables  4,  217,  232,  259  and  296,  Appendix  G. 

106 


CANCER  THROUGHOUT  THE  WORLD 

of  population.  The  highest  rate,  76.6,  was  for  European  countries,  and  the 
lowest,  33.4,  for  Africa.  For  the  American  continent  the  rate  was  65.7, 
which  is  above  the  rate  of  54.4  for  Asia  and  below  the  rate  of  73.0  for 
Australasia. 

The  statistical  data  are  given  in  three  separate  parts:  first,  for  the 
United  States,  second,  for  European  countries,  and  third,  for  foreign 
countries  other  than  Europe.  The  tables  for  the  United  States  number 
259,  and  for  foreign  countries  389.  The  tabular  presentation  of  the  data 
varies  considerably,  according  to  local  statistical  practice,  which  in  most 
countries  limits  the  returns  to  the  cancer  mortality  of  persons,  without 
reference  to  sex.  As  far  as  practicable,  the  mortality  by  age  and  organs 
and  parts  is  given  in  supplementary  tables ;  and  in  the  case  of  a  few  ex- 
ceptionally interesting  countries  without  vital  statistics  the  cancer 
morbidity  and  mortality  returns  of  hospitals  are  included.  A  seriously 
disturbing  factor  as  regards  comparability  of  rates  is  the  occasional 
limitation,  even  in  important  countries,  of  the  death  registration  to  large 
cities.  The  practical  utility  of  this  world-survey  of  cancer  would,  how- 
ever, have  been  much  diminished  if  only  the  countries  had  been  consid- 
ered for  which  entirely  complete  statistics  could  be  obtained.  For  many 
important  countries,  and  even  for  many  American  States,  the  accurate 
registration  of  vital  statistics  is  limited  to  large  cities,  and  these  are 
therefore  made  use  of  in  the  absence  of  more  complete  returns. 

It  has  not  been  feasible  to  standardize  all  the  crude  cancer  death  rates 
for  age  and  sex.  This  would  have  involved  for  many  countries  an  amount 
of  clerical  labor  which  would  not  only  have  unduly  delayed  the  publica- 
tion of  this  work,  but  which  in  all  probability  would  not  have  materially 
added  to  its  scientific  utility.  As  an  illustration  of  the  effect  of  such 
standardization  for  age  and  sex  the  following  table  is  included: 

Mortality  from  Cancer 
Standardized  for  Age  and  Sex  Constitution,  Rate  per  100,000  of  Population 

1906-1910 

Crude  Standardized 

Rate  Rate 

England  and  Wales 94  94 

Netherlands 103  93 

Australia 70  83 

New  Zealand 72  81 

Austria 78  73 

Prussia 74  73 

Ireland 79  64 

Spain 50  44 

Hungary 44  43 

It  will  be  observed  that  the  effect  of  such  standardization  for  age 
and  sex  for  the  more  important  countries,  such  as  Prussia  and  Hungary, 
is  almost  negligible;  the  effect  is  relatively  slight  for  the  Netherlands, 
Austria  and  Spain;  while  for  the  Australian  Commonwealth  and 
New  Zealand  the  crude  rates  are  increased.  The  most  important 
change  occurs  in  the  case  of  Ireland,  where  abnormal  conditions  prevail 
in  the  age  distribution,  as  a  result  of  a  heavy  and  continuous  emigration. 

107 


THE  MORTALITY  FROM  CANCER 


The  necessity  for  standardization  on  account  of  age  and  sex  in  the  case  of 
rural  communities  has  elsewhere  been  discussed.  For  certain  sections  of 
the  United  States,  like  Vermont,  for  illustration,  or  western  Massachu- 
setts, such  a  standardization  would  be  necessary  to  provide  a  strictly 
scientific  basis  of  comparison.  Since  the  cancer  mortality  data  for  prac- 
tically all  the  important  countries  and  cities  of  the  world  are  for  the 
first  time  here  brought  together  in  a  comprehensive  form,  it  should  not 
be  difficult  to  provide  a  factor  for  standardization  generally  applicable 
to  the  more  scientific  study  of  the  facts,  if  desirable  for  special  purposes. 

Cancer  Frequency  in  the  United  States 
The  mortality  from  cancer  in  the  registration  area  of  the  United 
States  is  presented  in  detail  in  Appendix  F  (Part  1),  in  74  tables. 
These  are  followed  by  185  tables  for  the  separate  states  and  cities,  subse- 
quently discussed,  with  the  required  brevity,  but  in  sufficient  detail  to 
emphasize  the  essentials  of  the  cancer  problem  for  particular  localities  in 
the  United  States.  According  to  Table  2,  the  cancer  death  rate  of  the 
registration  area  in  1913  was  78.9  per  100,000  of  population.  Applied 
to  the  estimated  total  population  of  the  Continental  United  States, 
this  would  represent  an  aggregate  cancer  mortality  of  76,319;  applied  to 
the  population  of  the  year  1915,  and  on  the  assumption  of  a  slight  in- 
crease in  the  rate,  the  approximate  cancer  mortality  for  that  year  may 
conservatively  be  placed  at  80,000.  Tables  3  and  4  are  for  the  states 
and  cities  of  the  registration  area,  followed  by  Tables  5  to  28,  inclusive, 
for  the  separate  registration  states.  The  results  for  the  five-year  period 
1908-12  are  summarized  in  the  table  below;  but  for  certain  states  the 
returns  are  not  for  the  entire  period. 

Mortality  from  Cancer  Standardized  for  Age 

United  States  Registration  Area,  1908-1912 

Rate  per  100,000  of  Population 


State 

Crude 

Standard- 

Rate 

ized  Rate 

Massachusetts 

93.2 

83.6 

Rhode  Island 

86.9 

82.7 

New  York 

83.3 
89.4 

80.4 

District  of  Columbia. 

80.4 

Minnesota 

68.6 

74.0 

California 

84.8 

72.6 

Connecticut 

78.7 

70.6 

Vermont 

102.2 

70.0 

Maine 

100.7 

69.8 

Wisconsin 

72.8 

69.7 

Maryland 

70.3 

68.3 

State 


Crude  Standard- 
Rate  ized  Rate 

Pennsylvania 65.2  67.8 

New  Hampshire 97.2  67.8 

Ohio 76.4  67.4 

Michigan 73.9  65.0 

New  Jersey 71.8  64.5 

Missouri 61.8  61.9 

Indiana 70.4  61.7 

Colorado 55.8  61.0 

Washington 49.5  55.8 

Montana 40.6  53.7 

Kentucky 43.8 48.3 


Local  Variations  in  Cancer  Frequency 

This  table  is  self-explanatory  and  emphasizes  the  local  variation  in 
the  cancer  death  rate,  due,  in  part,  to  the  varying  age  constitution  of  the 
population  of  the  states  considered.  The  range  in  crude  rates  is  from  a 
maximum  of  102.2  for  the  state  of  Vermont  to  a  minimum  of  40.6  for 
the  state  of  Montana,  or  a  difference  of  61.6  per  100,000  of  population. 
When  standardized  for  age  the  range  is  from  83.6  for  the  state  of 
Massachusetts  to  48.3  for  the  state  of  Kentucky,  a  variation  of  only 

108 


CANCER  THROUGHOUT  THE  WORLD 

35.3  per  100,000  of  population.  The  rates  for  Vermont,  Maine  and 
New  Hampshire  experience  the  greatest  change  by  standardization, 
for,  as  is  well  known,  these  states  contain  a  relatively  high  proportion 
of  persons  aged  45  and  over,  partly  on  account  of  the  absence  of  large 
cities.*  Since  all  cancer  death  rates  are  primarily  a  function  of  age,  it 
is  essential  to  keep  this  fact  in  mind;  but,  as  previously  pointed  out,  even 
when  full  standardization  is  made  for  variations  in  the  age  distribution 
of  the  population,  wide  differences  in  prevailing  cancer  death  rates  re- 
main. There  can  therefore  be  no  serious  question  of  doubt  that  the 
underlying  conditions  responsible  for  maximum  or  minimum  cancer 
death  rates  are  those  of  the  immediate  environment  as  affected  by 
topographical,  geological,  climatological,  sociological,  racial,  occupational 
and  numerous  other  conditions,  which  are  as  yet  but  imperfectly  known 
and  understood. 

In  view  of  the  debatable  borderland  of  malignancy  and  innocency  in 
tumor  formation,  it  has  seemed  advisable  to  include  Table  29,  which 
presents  the  combined  mortality  from  malignant  and  benign  tumors, 
estimated  for  the  Continental  United  States  on  the  basis  of  the  ascer- 
tained death  rate  for  the  registration  area,  which  for  the  year  1913  was 
82.2  per  100,000  of  population.  Recalling  that  the  estimated  number  of 
deaths  from  cancer  for  the  year  1913  was  76,319,  it  appears  by  this 
table  that  the  combined  mortality  from  malignant  and  benign  tumors 
for  that  year  was  79,567. 

Relative  Importance  of  Benign  Tumors 

For  the  purpose  of  facilitating  the  study  of  these  collateral  aspects  of 
the  cancer  problem,  Tables  33  to  38,  inclusive,  present  the  mortality  from 
benign  tumors  and  certain  related  causes  in  detail  for  the  period  1900-13, 
with  distinction  of  sex  and  for  both  sexes  combined.  The  forms  of  tumors 
and  other  diseases  included  are  hydatid  tumor  of  the  liver,  not  specified 
tumors  of  other  organs  of  males,  tumors  of  the  uterus  and  ovaries,  deaths 
from  ulcer  of  the  stomach,  biliary  calculi,  calculi  of  the  urinary  tract, 
and  finally,  deaths  from  all  benign  tumors  combined,  estimated  at 
3,248  for  the  year  1913.  These  tables  are  of  unusual  interest,  in  that 
they  furnish  the  required  answer  to  many  debatable  questions  and  the 
more  or  less  doubtful  interpretation  of  crude  cancer  mortality  statistics. 
The  total  mortality  from  benign  tumors,  it  may  be  said  in  this 
connection,  diminished  from  an  average  rate  of  4.4  in  the  year  1900  to 
3.4  for  the  year  1913.  This  reduction  may  possibly  be  and  probably 
is,  in  part,  due  to  a  transference  of  deaths  from  the  benign-tumor  class  to 
the  malignant-tumor  class,  as  a  result  of  more  precise  and  accurate 
methods  of  laboratory  diagnosis.  But  even  when  it  is  assumed  that  the 
entire  reduction  in  the  mortality  of  benign  tumors  was  thus  transferred, 
the  number  of  deaths  thus  accounted  for  could  have  increased  the  mor- 
tality from  cancer  in  the  year  1 9 1 3  by  only  968 .  In  contrast,  deaths  from 
ulcer  of  the  stomach  have  increased  since  the  year  1900,  when  the  rate 
was  2.6,  to  4.0  per  100,000  of  population  for  the  year  1913.  In  view  of  the 
improved  diagnosis  of  ulcer  of  the  stomach,  it  would  seem  quite  evident 
that  the  increase  in  the  recorded  mortality  has,  in  some  cases  at  least, 

*It  may  be  stated  in  this  connection  that  the  proportion  of  population  ages  45  and  over,  according  to  the 
Census  of  1910,  was  27.2  per  cent,  for  New  Hampshire,  27.1  per  cent,  for  Maine,  and  27.0  per  cent,  for  Vermont, 
compared  with  18.6  per  cent,  for  Washington,  17.7  percent,  for  Kentucky  and  16.2  per  cent,  for  Montana. 

109 


THE  MORTALITY  FROM  CANCER 

aflPected  the  mortality  from  cancer  to  the  extent  that  deaths  which 
would  formerly  have  erroneously  been  diagnosed  as  cancer  of  the  stom- 
ach or  adjacent  parts  are  now  more  correctly  diagnosed  as  deaths  from 
ulcer  of  the  stomach.* 

Mortality  from  Biliary  Calculi  and  Tumors  of  the  Uterus  and  Ovaries 

Particularly  significant  in  this  connection  is  the  recorded  increase  in 
the  mortality  from  biliary  calculi  and  calculi  of  the  urinary  tract.  The 
death  rate  for  the  former  is  evidently  excessive  among  females,  and  the 
increase  in  the  rate  has  been  greater  during  recent  years;  whereas  the 
mortality  from  the  latter  is  higher  among  males,  but  in  this  case  also,  the 
relative  increase  in  the  rate  has  been  greater  for  women  than  for  men. 

Deaths  from  benign  tumor  of  the  uterus  have  increased  from  2.6  in 
the  year  1900  to  3.8  per  100,000  of  female  population  in  1913,  but  the 
rate  has  been  subject  to  considerable  fluctuations,  and  on  the  whole  may 
be  said  to  have  been  rather  stationary.  Deaths  from  tumor  of  the 
ovaries  appear  to  have  diminished;  but  here  also,  considering  the  small- 
ness  of  the  rate,  the  changes  have  not  been  of  material  importance. 

Tables  31  and  32  differentiate  the  mortality  from  cancer  in  the 
registration  area  of  the  United  States  by  sex.  For  the  year  1913  the 
male  cancer  death  rate  was  61.3  and  the  female  rate  was  97.6.  The 
excess  of  the  female  rate  of  the  cancer  deaths  for  that  year  was  therefore 
36.3  per  100,000  of  population,  or  59.2  per  cent. 

Tables  41  to  46,  inclusive,  show  the  mortality  from  cancer  by  groups 
of  organs  and  parts,  according  to  sex,  in  conformity  to  the  International 
Classification  of  causes  of  death.  The  results  for  the  period  1908-12 
are  briefly  summarized  in  the  table  below. 

Mortality  from  Cancer,  by  Organs  and  Parts,  according  to  Sex 
United  States  Registration  Area,  1908-1912 

Rate  per  100,000  Population 
Organ  or  Part  Total  Males  Females 

Buccal  cavity 2.8  4.6  1.0 

Stomach  and  liver 29.6  28.8  30.5 

Peritoneum,  intestines  and  rectum .  9.5  7.7  11.3 

Female  generative  organs 11.4  .  .  23.4 

Female  breast 7.0  .  .  14.3 

Skin 2.8  3.5  2.1 

Other  or  not  specified  organs 11.6  13.2  10.0 

All  organs  and  parts 74.7 57.7 92.6 

Aggregate  Mortality  from  Tumors 

The  total  mortality  from  cancer  in  the  Continental  United  States  has 
been  estimated  on  the  basis  of  the  actual  rates  by  groups  of  organs  and 
parts  for  the  registration  area  for  the  year  1913.  These  estimates  are 
here  given  only  in  a  summary  form.  The  details  for  each  group  for  single 
years  since  1900  are  given  in  Table  47,  Appendix  F,  (Part  1). 

*The  pathologic  relationship  of  gastric  ulcer  and  carcinoma  has  been  made  the  subject  of  a  special  and  ex- 
tended investigation  by  the  Mayo  Clinic  of  Rochester,  Minn.  The  evidence  of  such  a  relationship  appears  to 
have  been  conclusively  established,  as  brought  out  by  fifteen  micro-photographs  of  specimen  cases  exhibited 
on  the  occasion  of  the  meeting  of  the  American  Medical  Association,  Atlantic  City,  1914. 

110 


CANCER  THROUGHOUT  THE  WORLD 

Estimated  Total  Mortality  from  Cancer,  by  Organs  and  Parts 
Continental  United  States,  1913 

Rate  per  Number 

100,000  of  Percentage 

Organ  or  Part  Population  Deaths  Distribution 

Buccal  cavity 3.11  3,007  3.94 

Stomach  and  liver 31.23  30,215  39.59 

Peritoneum,  intestines  and  rectum.  10.47  10,128  13.27 

Female  generative  organs 12.17  11,776  15.43 

Breast 7.25  7,021  9.20 

Skin 2.73  2,633  3.45 

Other  or  not  specified  organs 11.92  11,539  15.12 

All  organs  and  parts 78.88         76,319         100.00 

Increase  by  Organs  and  Parts  of  the  Body 
The  analysis  in  detail  of  these  tables  amply  supports  the  conclusion 
not  only  that  cancer  in  the  aggregate  is  on  the  increase,  but  that  there 
has  been  a  rise  in  the  recorded  and  specified  cancer  death  rate  in  the 
United  States  for  every  important  group  of  organs  or  parts  of  the  body 
affected  by  malignant  disease.  During  the  period  1900-12  cancer  of  the 
buccal  cavity  increased  from  1.6  to  3.0;  cancer  of  the  stomach  and 
liver,  from  22.5  to  30.6;  cancer  of  the  peritoneum,  intestines  and  rectum, 
from  5.7  to  9.8;  cancer  of  the  female  generative  organs,  from  8.8  to  11.7 
(or  on  the  basis  of  female  population,  from  17.5  to  24.2) ;  cancer  of  the 
female  breast  increased  from  4.5  to  7.2  (or  on  the  basis  of  female  popu- 
lation, from  9.1  to  14.9) ;  cancer  of  the  skin,  from  2.0  to  2.9;  but  cancer 
of  other  organs  and  parts  decreased  from  17.9  to  11.7.  This  decrease, 
of  course,  is  of  considerable  importance,  in  that  practically  the  whole  of 
it  affects  the  increase  in  the  cancer  mortality  of  specified  organs  and 
parts ;  but  it  will  be  observed  by  reference  to  Table  46  that  this  de- 
crease has  practically  come  to  an  end  since  1908,  and  although  the  total 
cancer  death  rate  during  this  period  has  increased  from  71.5  to  77.0,  all  of 
this  increase  has  fallen  upon  specified  organs  and  parts,  which  it  is  safe 
to  assume  are  at  the  present  time  not  subject  to  very  material  alterations 
in  precise  diagnosis,  or  in  any  event  not  sufficiently  so  to  account  for 
this  considerable  augmentation  of  the  cancer  death  rate  during  so  short 
a  period  as  five  years. 

To  facilitate  the  scientific  study  of  the  cancer  death  rates,  the  popula- 
tion statistics  for  the  registration  area  by  sex  and  ages  are  given  in  full 
detail  in  Table  48.  This  table  shows  separately  the  estimated  population 
for  the  decade  ending  with  1912  and  the  two  quinquennial  periods 
ending  with  1907  and  1912.  Since  for  medical  purposes  cancer  death 
rates  for  ages  45  and  over  are  most  useful,  the  aggregate  population 
for  this  age  period  is  given  separately;  to  facilitate  comparison  with 
the  English  statistics  by  age,  the  divisional  periods  of  life  have  been 
arranged  in  a  corresponding  manner,  and  also,  of  course,  in  conformity 
to  the  age  grouping  adopted  by  the  United  States  Census  Office. 

Cancer  Increase  by  Age  and  Sex 

Tables  49  to  55,  inclusive,  present  the  cancer  mortality  of  the  United 
States  registration  area  for  the  decade  ending  with  1912,  by  sex  and 
divisional  periods  of  life,  for  all  forms  of  cancer  as  well  as  for  the  separate 

111 

0 


THE  MORTALITY  FROM  CANCER 


groups  of  organs  and  parts.  These  tables  should  prove  of  exceptional 
practical  utijiity  especially  in  the  medical  study  of  the  cancer  problem, 
as  regards  the  true  incidence  of  different  forms  of  cancer  frequency  ac- 
cording to  age  and  sex.  The  results  for  cancer  of  all  organs  and  parts 
of  the  body  are  summarized  in  the  following  table: 

Mortality  from  Cancer,  by  Age  and  Sex,  United  States  Registration  Area 

1908-1912 


Males 
Rate 
per 
Ages  100,000 

Under  10 2.5 

10-24 3.1 

25-34 9.0 

35-44 32.3 

45-54 105.4 

55-64 257.4 

65-74 452.8 

75  and  over 620.2 

All  ages* 55.7 

45  and  over 236.5 


Females 
Rate 
per 

100,000 

2.2 

2.8 
20.6 
89.0 
222.9 
386.4 
565.7 
734.1 

90.6 
366.4 


Excess  or  Deficiency  in  the 
Female  Rate 
Compared  with  the  Male  Rate 
Per  Cent. 


+ 
+ 


Actual 

-  0.3 

-  0.3 
11.6 
56.7 

+  117.5 
+  129.0 
+  112.9 
+  113.9 

+  34.9 
+  129.9 


—  12.0 

—  9.7 
+  128.9 
+  175.5 
+  111.5 
+  50.1 
+  24.9 
+  18.4 


+ 
+ 


62.7 
54.9 


*Including  unknown  ages. 

Briefly,  it  is  shown  that  the  cancer  mortality  of  females  exceeds  the 
cancer  mortality  of  males  at  all  ages  over  24.  The  actual  excess  is  most 
pronounced  at  ages  55  to  64,  but  the  relative  excess  is  greatest  at  ages 
35  to  44,  when  the  cancer  mortality  of  females  is  175.5  per  cent,  in 
excess  of  the  cancer  mortality  of  males.  At  ages  45  and  over  the  cancer 
death  rate  of  males  is  236.5,  but  of  females  it  is  366.4.  There  is,  therefore, 
an  actual  excess  in  the  female  cancer  death  rate  of  129.9  per  100,000  of 
population,  equivalent  to  54.9  per  cent.  The  excess  in  the  female  cancer 
death  rate  is  primarily  due  to  the  excessive  frequency  of  cancer  of  the 
female  generative  organs  and  the  breast. 

Proportionate  Cancer  Mortality  in  the  United  States 
The  study  of  the  subject  may  be  approached  from  another  point  of 
view,  but  with  less  assurance  of  accuracy  in  the  results.  For  certain 
purposes,  however,  the  proportionate  mortality  is  of  value  when  the 
correct  rate  of  incidence  can  not  be  determined  on  the  basis  of  the  existing 
population  of  corresponding  ages.  Table  57  has  therefore  been  in- 
cluded, but  the  results  are  given  only  in  a  summary  form  for  the  five 
years  ending  with  1912,  and  according  to  sex  and  by  five-year  periods 
of  life,  subsequently  summarized  for  ages  under  15,  ages  15  to  44,  ages 
45  to  64,  and  65  and  over.  The  proportionate  mortality  as  determined 
by  this  method  for  ages  45  to  64  was  7.8  per  cent,  of  the  deaths  from  all 
causes  for  males,  and  16.8  per  cent,  for  females. 

In  a  similar  manner  the  relative  mortality  from  cancer  in  comparison 
with  that  from  other  important  causes  of  death  has  been  summarized  in 
Table  58  for  ages  under  45,  and  45  and  over,  with  distinction  of  sex.  This 
table  should  prove  particularly  useful  in  discussions  of  public-health 
problems,  for  the  purpose  of  visualizing  the  relative  importance  of  cancer 

112 


CANCER  THROUGHOUT  THE  WORLD 

as  a  leading  cause  of  death  in  adult  life  demanding  a  much  more 
active  interest  on  the  part  of  the  medical  and  surgical  profession  and 
the  laity  than  has  heretofore  been  the  case. 

Cancer  Mortality  by  Season 
The  cancer  death  rate  is  apparently  but  very  slightly,  at  least  in  the 
United  States,  affected  by  season,  or  the  months  of  the  year.  Table  59 
has  been  included  as  a  brief  contribution  to  this  phase  of  the  cancer 
problem,  the  same  being  based  upon  the  returns  for  the  decade  ending 
with  1911  of  the  states  of  New  York,  Massachusetts,  New  Hampshire 
and  Connecticut.  The  range  in  the  monthly  cancer  death  rate  was 
from  a  minimum  of  6.3  for  January  and  June  to  a  maximum  of  6.7  for 
August  and  October.     The  monthly  average  rate  for  the  year  was  6.5. 

Details  of  Increase  by  Organs  and  Parts  of  the  Body 

The  increase  in  cancer,  as  shown  by  the  annual  returns  for  the  American 
States  and  the  registration  area  as  a  whole,  is  more  accurately  disclosed  by 
the  specialized  analysis  of  data  for  the  registration  area,  first,  for  all  forms 
of  cancer  according  to  age  and  sex,  and  second,  for  the  six  principal 
groups  of  specified  organs  and  parts.  To  avoid  too  elaborate  a  method 
of  comparison,  it  has  been  considered  sufficient  to  limit  the  same  to  the 
two  five-year  periods  ending  with  1907  and  1912.  The  details  of  this 
analysis  are  set  forth  in  Tables  61  to  74,  inclusive,  in  a  uniform 
manner,  showing  in  each  case  the  actual  number  of  deaths  from 
cancer  and  the  rate  per  100,000  of  population  by  divisional  periods 
of  life.  The  population  data  used  in  this  analysis  are  given  in  full 
in  Table  48.  These  tables  are  of  exceptional  medical  and  surgical 
interest,  and  they  will  meet  practically  every  reasonable  requirement 
for  a  more  adequate  discussion  of  the  statistical  aspects  of  the  cancer 
problem,  with  special  reference  to  the  United  States  at  the  present 
time.  It  has  not  been  feasible  to  summarize  the  results  of  these  tables, 
but  in  brief  they  may  be  said  to  confirm  the  broad  conclusion  that 
cancer  is  on  the  increase  in  the  United  States,  not  only  when  considered 
in  the  aggregate,  but  when  every  important  form  of  cancer  or  organ 
or  part  of  the  body  affected  locally  by  malignant  disease  is  separately 
considered.  There  are,  however,  probably  some  important  exceptions 
to  this  far-reaching  conclusion,  which  unfortunately,  on  account  of 
the  lack  of  adequate  data  can  not  be  conclusively  established  by  the 
statistical  method  at  the  present  time.  The  reason  for  this  limitation  is 
to  be  found  in  the  transfer  of  cancer  deaths  from  the  formerly  rather 
large  not-specified  group  to  the  groups  of  cancer  of  specified  organs  and 
parts.  It  may  be  pointed  out  in  this  connection  that,  regardless  of  a 
general  tendency  towards  cancer  increase,  there  has  been  a  decrease  in 
cancer  frequency  among  males  at  ages  10  to  44  and  among  females  at 
ages  25  to  54,  when  the  rates  for  the  five-year  period  ending  with  1912 
are  compared  with  the  rates  for  the  five-year  period  ending  with  1907. 

The  mortality  from  cancer  of  the  buccal  cavity  remains  practically  the 
same  at  all  age  periods  for  males  at  ages  under  45  and  for  females  at 
ages  under  55,  excepting  ages  10  to  24.  This  interesting  result  is 
probably,  in  part  at  least,  attributable  to  the  generally  successful 
operative  treatment  for  this  form  of  cancer.     There  was  either  a  very 

113 


THE  MORTALITY  FROM  CANCER 

slight  actual  increase  or  decrease  in  the  mortality  of  both  sexes  from 
cancer  of  the  stomach  at  ages  under  55.  This  likewise  is  of  much 
practical  significance,  and  again,  it  is  a  safe  conclusion  that  the  reduction 
is  primarily  the  result  not  of  diminished  liability  to  cancerous  affections, 
but  to  a  reduced  mortality  in  consequence  of  successful  operative  and 
medical  treatment.  At  ages  55  and  over,  there  has  been  a  considerable 
increase  in  the  mortality  from  cancer  of  the  stomach  and  liver  in  recent 
years,  and  for  both  sexes.  For  males  the  percentage  increase  was  12.0, 
ages  55  to  64;  12.4,  ages  65  to  74;  and  27.3,  ages  75  and  over.  For 
females  the  percentage  increase  was  14.3,  ages  55  to  64;  14.4,  ages  65 
to  74;  and  26.3,  ages  75  and  over.  In  contrast,  the  mortality  from 
cancer  of  the  peritoneum,  intestines  and  rectum  has  increased  for  both 
males  and  females  at  every  period  of  life  above  the  age  of  10.  Cancer 
of  the  female  generative  organs  has  increased  at  every  divisional  period 
of  life  and  cancer  of  the  female  breast  at  all  ages  over  25.  It  is  significant 
that  the  mortality  from  cancer  of  the  breast  at  ages  under  25  should 
have  been  stationary,  when  deaths,  though  rare,  are  liable  to  occur. 
Cancer  of  the  skin  has  increased  for  males  at  all  ages,  while  for  females 
the  rate  has  shown  only  very  slight  changes  at  all  ages  under 
65.  The  mortality  from  cancer  by  organs  and  parts  not  specified  has 
decreased  for  both  sexes  at  every  divisional  period  of  life.  The  correct 
interpretation  of  these  statistics  is  rather  difficult  and  more  extended 
returns  will  be  required  before  it  will  be  safe  to  employ  more  refined 
methods  of  analysis;  but  the  data  seem  to  admit  of  no  exception  to 
the  important  and  far-reaching  conclusion  that  the  mortality  from  cancer 
of  all  important  organs  and  parts,  and  for  both  sexes,  has  increased  more 
or  less  at  all  ages  over  50,  when,  of  course,  numerically,  the  mortality  from 
malignant  disease  is  of  the  greatest  practical  significance. 
Age  Incidence  of  Cancer 

To  further  facilitate  the  study  of  the  age  incidence  of  cancer  fre- 
quency in  the  registration  area  of  the  United  States,  Table  60  is 
included.  This  table  exhibits  the  crude  and  standardized  death  rates 
per  100,000  of  population  of  the  states  included  in  the  registration  area  in 
1900,  compared  for  the  years  1901  and  1911,  and  the  relative  mortality 
for  1911,  on  a  percentage  basis,  compared  with  that  for  1901.  It  is  shown 
by  this  table  that  for  both  sexes  at  ages  25  and  over  the  cancer  death  rate 
of  1911  was  25  per  cent,  in  excess  of  the  rate  for  1901.  For  males  the 
rate  for  1911  was  29  per  cent,  in  excess,  and  for  females,  23  per  cent. 
This  table  is  derived  from  the  Census  Report  on  mortality  statistics 
for  1911.  For  all  of  the  other  tables  of  the  United  States  only  the 
original  data  are  derived  from  the  Census  publications,  the  rates  in  every 
case  having  been  recalculated  and  rearranged  for  the  present  purpose, 
so  as  to  make  the  comparison  uniform,  as  far  as  practicable,  not  only  for 
the  several  states  and  cities,  but  also  for  foreign  countries.* 

Cancer  Mortality  Data  of  the  New  York  Pathological  Institute 

Under  an  arrangement  with  the  New  York  State  Board  of  Health,  the 
New  York  State  Institute  for  the  Study  of  Malignant  Disease  receivedf 

*Tlie  mortality  froin  sarfoiiia  and  from  all  other  forms  of  cancer  are  given  in  full,  by  single  years  of  life,  in 
Appendix  D,  Experience  Data  of  American  and  Foreign  Life  Insurance  Companies. 

fAccording  to  an  ofiBcial  statement  the  cooperative  arrangement  between  the  State  Institute  for  the  Study 
of  Malignant  Disease  and  the  Slate  Board  of  Health  was  unfortunately  diuicontinued  subsequent  to  June,  1914. 

114 


CANCER  THROUGHOUT  THE  WORLD 

a  transcript  of  the  official  certificate  of  every  death  from  cancer,  including 
some  additional  data  of  special  interest.  The  returns,  more  or  less  com- 
plete, have  been  received  under  this  agreement  from  every  county  and 
city  of  the  state,  except  Greater  New  York,  for  the  year  1913.*  The 
number  of  deaths  from  cancer  returned  in  this  manner  was  2,041,  of 
which  1,733,  or  Q5.5  per  cent.,  were  deaths  of  women.  A  summary 
statement  by  organs  and  parts  of  the  body  affected  is  given  below : 

Analysis  of  Cancer  Deaths  in  the  State  of  New  York  (Excepting  Greater 

New  York)  as  Returned  to  the  New  York  State  Institute 

for  the  Study  of  Malignant  Disease,  1913t 

Males  Females 

Organ  or  Part  Number  Per  Cent.  Number  Per  Cent. 

Buccal  cavity 92  10.1  14  0.8 

Stomach  and  liver 400  44.1  544  31.4 

Peritoneum,  intestines,  rectum .  137  15.1  220  12.7 

Female  generative  organs . .  456  26.3 

Breast 5  0.5  314  18.1 

Skin 5Q  6.2  27  1.6 

Other  organs  and  parts . 218  24.0  158  9.1 

Total 908  100.0  1,733  100.0 

fSee  blank  form  used  in  Table  3,  Appendix  B. 

The  returns  are  classified  in  detail  in  this  chapter,  according  to 
which  there  were  66  specified  organs  or  parts  of  the  body  affected, 
the  largest  number  of  deaths  of  males  from  cancer  having  been  due  to 
cancer  of  the  stomach,  which  accounted  for  281,  or  30.9  per  cent,  of  the 
total  deaths  of  males  from  malignant  disease.  Cancer  of  the  uterus 
accounted  for  the  largest  number  of  deaths  from  cancer  among  women, 
or  23.1  per  cent,  of  the  total  deaths  from  cancer  of  all  organs  and  parts 
of  the  body. 

The  New  York  State  investigation  for  the  first  time  throws  light 
upon  the  approximate  previous  duration  of  cancer,  and  the  summary 
table  below  illustrates  the  general  results,  according  to  sex : 

Previous  Duration  of  Malignant  Disease,  according  to  Sex 

New  York  State  Institute  for  the  Study  of 

Malignant  Disease,  1913 

Males  Females 

Duration  Number  Per  Cent.  Number  Per  Cent. 

Under  1  year 321  39.4  465  29.6 

1  to  4  years 465  57.2  1,003  64.0 

5  years  and  over .  .        28  3.4  98  6.4 

Total  stated 814  100.0  1,566  100.0 

*0f  the  4,313  deaths  from  cancer  occurring  in  New  York  state  (Greater  New  York  excluded)  in  1913, 
returns  for  2,C41  were  made  to  the  New  York  State  Institute  for  the  Study  of  Malignant  Disease. 

115 


THE  MORTALITY  FROM  CANCER 

Of  the  male  deaths  from  cancer  39.4  per  cent,  show  a  previous  dura- 
tion of  disease  of  less  than  one  year,  against  29.6  per  cent,  of  the  female 
deaths.  The  percentage  of  deaths  with  a  previous  disease  duration  of 
five  years  or  more  was  3.4  for  males  and  6.4  for  females.  The  large  ma- 
jority of  cancer  deaths  followed  a  previous  duration  of  from  six  to 
twenty -four  months.  The  average  duration  of  previous  disease  was  22 
months  for  males  and  26  months  for  females.  The  New  York  State 
investigation  also  includes  an  inquiry  into  the  previous  family  history  of 
cancer.     The  table  following  briefly  summarizes  the  results : 

Family  History  of  Cancer  or  Heredity 
New  York  State  Institute  for  the  Study  of  Malignant  Disease,  1913 

Males  Females 

Family  History  Number  Per  Cent.  Number  Per  Cent. 

Yes 104  12.5  245  16.1 

No 731  87.5  1,279  83.9 

Total  stated 835  100.0  1,524  100.0 

Notstated 73  ..  209 

Grand  total 908  ..  1,733 

It  is  brought  out  by  this  table  that  definite  evidence  of  a  family 
history  from  cancer  was  obtained  in  12.5  per  cent,  of  cancer  deaths  of 
males,  against  16.1  per  cent,  of  cancer  deaths  of  females.  Another  impor- 
tant result  of  the  New  York  State  inquiry  is  information  regarding  the 
microscopical  examination  of  cancerous  tissue.  It  was  brought  out 
that  of  the  male  cases  of  cancer  21.9  per  cent,  had  been  diagnosed 
upon  the  basis  of  microscopical  findings,  against  23.2  per  cent,  of  the 
female  cases. 

Primary  Seat  of  Growth,  Probable  Cause  and  Personal  History 

Some  extremely  interesting  details  disclosed  by  investigation  re- 
garding the  primary  seat  of  growth,  the  probable  cause  and  the  personal 
history  are  summarized  for  the  more  important  organs,  below: 

Cancer  of  the  Bladder.  Males:  32  deaths;  average  age,  64  years.  Primary 
seat  of  growth:  bladder,  27;  prostate,  4;  ureter,  1.  Probable 
cause:  trauma,  4;  urinary  calculi,  1;  enlarged  prostate,  1;  venereal 
disease,  1.  Personal  history:  alcoholism,  6;  enlarged  prostate,  1; 
syphilis,  1;  tuberculosis,  1.  Females:  18  deaths;  average  age,  65 
years.  Primary  seat  of  growth:  bladder,  15;  labia,  1;  uterus,  1; 
urethra,  1.  Probable  cause:  calculi,  1;  cervical  tear,  3;  urethral 
carbuncle,  1. 

Cancer  of  the  Female  Breast.  314  deaths;  average  age,  61  years.  Primary 
seat  of  growth:  breast,  304;  axilla,  5;  lung,  2;  scapula,  1;  uterus,  1; 
not  stated,  1.  Probable  cause:  trauma,  44 ;  childbirth,  13;  mastitis, 
7;  tumor  of  breast,  5;  abscess  of  breast,  2;  ulcerated  nipple,  1; 
fissure  breast,  1.  Personal  history:  tuberculosis,  13;  alcoholism,  3; 
syphilis,  2. 

116 


CANCER  THROUGHOUT  THE  WORLD 

Cancer  of  the  External  Female  Organs  of  Generation.  16  deaths;  average 
age,  72  years.  Primary  seat  of  growth:  vulva,  7;  labia,  7;  others,  2. 
Probable  cause:  ulcer,  2;  gonorrhoeal  warts,  1;  cervical  tear,  1; 
prolapse  uterus,  1 ;  eczema,  1.  Personal  history :  gonorrhoea,  1 ;  gall- 
stones, 1;  cystitis,  1;  psoriasis,  1;  diabetes,  1. 

Cancer  of  the  Gall-bladder.  Males:  8  deaths;  average  age,  66  years. 
Primary  seat  of  growth:  gall-bladder,  8.  Probable  cause:  gall- 
stones, 3;  trauma,  1.  Females:  24  deaths;  average  age,  68  years. 
Primary  seat  of  growth:  gall-bladder,  23;  not  stated,  1.  Probable 
cause:  gall-stones,  7;  trauma,  1;  gastric  ulcer,  1.  Personal  history: 
cholelithiasis,  7;  indigestion,  1. 

Cancer  of  the  Intestines.     Males:  75  deaths;  average  age,   63  years. 
Primary  seat  of  growth:  intestines,  62;  stomach,  4;  rectum,  3 
bladder,  1;  liver,  1;  mesentery,  1;  peritoneum,  1;  not  stated,  2 
Probable  cause :  trauma,  9;  ulcer  of  stomach,  3;  ulcer  of  intestines,  2 
appendicitis,  1.     Personal  history:  alcoholism,  12;  tuberculosis,  3 
constipation,   3;   gall-stones,    1;   hernia,    1;   enlarged  prostate,   1 
Females:  166  cases;  average  age,  62  years.    Primary  seat  of  growth 
intestines,  131;  uterus,  9;  stomach,  6;  breast,  5;  fallopian  tube,  1 
gall-bladder,  1;  rectum,  1;  ovary,  1;  spleen,  1;  pancreas,  1;  peri- 
toneum, 1.    Probable  cause :  trauma,  5 ;  appendicitis,  3 ;  childbirth,  3 ; 
metritis,  2;  typhoid,  1 ;  ulcer,  1 ;  mastitis,  1 ;  gastric  ulcer,  1 ;  hernia,  1. 
Personal  history:  indigestion,   10;  tuberculosis,   6;   alcoholism,  1; 
ovarian  disease,  2;  hernia,  1. 

Cancer  of  the  Jaw.  Males:  30  deaths;  average  age,  65  years.  Primary 
seat  of  growth:  jaw,  19;  gums,  3;  lip,  3;  tongue,  cheek,  tooth,  mouth 
and  not  stated,  1  each.  Probable  cause:  teeth,  7;  smoking,  4. 
Personal  history :  alcoholism,  8;  cancer  of  jaw,  abscess  of  jaw  and 
tuberculosis,  1  each.  Females:  7  deaths;  average  age,  66  years. 
Primary  seat  of  growth:  jaw,  5;  eye,  1;  nose,  1.  Probable  cause: 
ulcerated  tooth,  1;  smoking,  1;  mole,  1.  Personal  history:  tuber- 
culosis, 1. 

Cancer  of  the  Kidneys.  Males:  11  deaths;  average  age,  59  years.  Primary 
seat  of  growth :  kidney,  10 ;  cheek,  1 .  Probable  cause :  gonorrhoea,  1 ; 
trauma,  1;  abscess  of  kidney,  1.  Personal  history:  alcoholism,  2; 
appendicitis,  1.  Females:  3  deaths ;  average  age,  55  years.  Primary 
seat  of  growth :  kidney,  3.     Personal  history :  tuberculosis,  1. 

Cancer  of  the  Lips.  Males:  22  deaths;  average  age,  74  years.  Primary  seat 
of  growth:  lips,  20;  jaw,  2.  Probable  cause:  smoking,  14;  cut  lip,  1; 
ulcer  of  lip,  1;  wart,  1;  tooth,  1.  Personal  history:  alcoholism,  3; 
syphilis,  1. 

Cancer  of  the  Liver.  Males:  89  deaths;  average  age,  62  years.  Primary 
seat  of  growth:  liver,  69;  stomach,  6;  gall-bladder,  2;  testicle,  2; 
cheek,  spleen,  abdomen,  rectum,  eye  and  axilla,  1  each;  not  stated  4. 
Probable  cause:  trauma,  8;  gastritis,  3;  rich  food,  ulcer  of  stomach, 
-  lead-poisoning,  gall-stones,  indigestion,  prostatitis  and  appendicitis, 
1  eachTTersonal  history:  alcoholism,  12;  tuberculosis,  4 ;  syphilis,  4. 
Females:  184  deaths ;  average  age,  63  years.  Primary  seat  of  growth : 
liver,  126;  gall-bladder,  23;  breast,  13;  stomach,  6;  uterus,  4; 
mesentery,  2;  kidney,  ear,  pancreas,  colon,  rectum   and   ovary, 

117 


THE  MORTALITY  FROM  CANCER 

1  each;  not  stated,  4.  Probable  cause:  gall-stones,  13;  cervical  tear, 
5;  trauma,  6;  childbirth,  6;  ulcer  of  stomach,  2;  abscess  of  liver, 
cancer  of  lip,  cancer  of  ear  and  ulcer  of  intestines,  1  each.  Personal 
history:  tuberculosis,  8;  alcoholism,  5;  congestion  of  liver,  syphilis 
and  icterus,  1  each. 

Cancer  of  the  Lungs.  Males:  6  deaths;  average  age,  61  years.  Primary 
seat  of  growth:  lung,  stomach,  axilla  and  thigh,  1  each;  not  stated,  2. 
Probable  cause:  trauma,  3;  gastric  ulcer,  1.  Females:  11  deaths; 
average  age,  55  years.  Primary  seat  of  growth :  breast,  9;  shoulder, 
2.  Probable  cause:  trauma,  2;  pneumonia,  1;  cancer  of  breast,  1. 
Personal  history:  tuberculosis,  2. 

Cancer  of  the  Mouth.  Males:  8  deaths;  average  age,  72  years.  Primary 
seat  of  growth:  jaw,  5;  gums,  1;  cheek,  1;  lip,  1.  Probable  cause: 
ulcer  of  tooth,  5;  smoking,  2.  Personal  history:  tuberculosis,  1; 
eczema,  1. 

Cancer  of  the  Neck.  Males:  26  deaths ;  average  age,  63  years.  Primary  seat 
of  growth:  neck,  17;  maxilla,  2;  lip,  2;  larynx,  cervical  gland,  collar 
bone,  parotid  and  skin,  1  each.  Probable  cause :  smoking,  2;  strain, 
1;  cat  scratch,  1.  Personal  history:  alcoholism,  7;  tuberculosis, 
syphilis  and  cancer  of  neck,  1  each.  Females:  5  deaths ;  average  age, 
67  years.  Primary  seat  of  growth:  parotid,  breast,  nose,  neck  and 
sub-maxillary,  1  each.  Probable  cause:  smoking,  1.  Personal 
history :  alcoholism,  1. 

Cancer  of  the  (Esophagus.  Males:  16  deaths;  average  age,  58  years.  Pri- 
mary seat  of  growth :  oesophagus,  13;  stomach,  2;  not  stated,  1.  Prob- 
able cause :  smoking,  1 ;  rapid  eating,  1 .  Personal  history :  alcoholism, 
5;  paralysis,  1.  Females:  10  deaths;  average  age,  64  years.  Primary 
seat  of  growth :  oesophagus,  8 ;  larynx,  1 ;  breast,  1.  Personal  history : 
tuberculosis,  1 ;  alcoholism,  1. 

Cancer  of  the  Ovaries.  21  deaths;  average  age,  54  years.  Primary  seat 
of  growth:  ovaries,  17;  breast,  stomach,  uterus  and  not  stated,  1 
each.  Probable  cause:  childbirth,  4;  ovarian  cyst,  1.  Personal 
history :  gonorrhoea,  1 ;  pelvic  inflammation,  1 ;  tuberculosis,  2. 

Cancer  of  the  Pancreas.  Males:  18  deaths;  average  age,  59  years. 
Primary  seat  of  growth:  pancreas,  14;  stomach,  abdomen,  liver  and 
not  stated,  1  each.  Probable  cause :  trauma,  2.  Personal  history : 
alcoholism,  1.  Females:  24  deaths;  average  age,  64  years.  Primary 
seat  of  growth:  pancreas,  18;  gall-bladder,  1;  epigastrium,  1;  not 
stated,  4.  Probable  cause:  gall-stones,  3;  prolapse  of  uterus,  1; 
miscarriage,  1.  Personal  history:  tuberculosis,  2;  pancreatitis,  1; 
goitre,  1. 

Cancer  of  the  Peritoneum.  Males:  6  deaths;  average  age,  47  years. 
Primary  seat  of  growth:  peritoneum,  ureter,  retro-peritoneal  gland, 
testicle,  mesentery  and  not  stated,  1  each.  Probable  cause :  trauma, 
1;  gonorrhoea,  1.  Personal  history:  syphilis,  1;  asthma,  1.  Females: 
6  deaths;  average  age,  52  years.  Primary  seat  of  growth:  perito- 
neum, sigmoid,  bladder  and  pelvic  organs,  1  each;  not  stated,  2. 
Probable  cause:  perineal  tear,  1.  Personal  history:  syphilis,  1; 
gastritis,  1. 

118 


CANCER  THROUGHOUT  THE  WORLD 

( ^anccr  of  the  Pharynx.     Males:  6  deaths ;  average  age,  60  years.  Primary 

seat  of  growth:  pharynx,  2;  jaw,  2;  tonsil,  1;  mouth,  1.  Probable 

cause:  smoking,  3;  tooth-extraction,  1;  ulcer  of  gum,  1.  Personal 
history:  alcoholism,  2. 

Cancer  of  the  Prostate  Gland.  36  deaths ;  average  age,  70  years.  Pri- 
mary seat  of  growth :  prostate,  35 ;  urethra,  1 .  Probable  cause :  pros- 
tatitis, 3;  stricture  of  urethra,  2;  trauma,  1;  gonorrhoea,  1.  Personal 
history:  alcoholism,  8;  sexual  excess,  syphilis,  tuberculosis  and 
hernia,  1  each. 

Cancer  of  the  Rectum.  ifcfaZes;  56  deaths;  average  age,  63  years.  Primary 
seat  of  growth:  rectum,  46;  prostate,  3;  lip,  sigmoid,  bladder  and 
hip  joint,  1  each;  not  stated,  3.  Probable  cause:  piles,  5;  trauma,  3; 
diarrhoea,  2;  prostatitis,  1.  Personal  history:  lead-poisoning,  1; 
alcoholism,  5.  Females:  48  deaths;  average  age,  62  years.  Primary 
seat  of  growth:  rectum,  42;  ovaries,  4;  sigmoid,  1;  uterus,  1.  Prob- 
able cause :  trauma,  4 ;  cervical  tear,  4 ;  rectal  ulcer,  1 ;  childbirth,  2 ; 
constipation,  1;  piles,  3;  pruritus  ani,  1.  Personal  history:  tuber- 
culosis, 1 ;  diabetes,  1 ;  uterine  fibroid,  1. 

Cancer  of  the  Skin.  Males:  56  deaths;  average  age,  71  years.  Primary 
seat  of  growth :  nose,  9 ;  ear,  9 ;  face,  7 ;  eye,  7 ;  cheek,  6 ;  lip,  5 ;  maxilla, 
3 ;  temple,  mastoid,  teeth  and  sacrum,  1  each ;  not  stated,  6 .  Probable 
cause:  trauma,  14;  smoking,  3;  mastitis,  cleft  palrte,  ulcer  of  tooth, 
irritation  from  glasses,  ulcer  of  nose  and  irritation,  1  each.  Personal 
history:  alcoholism,  9;  tuberculosis,  1;  cataract,  1;  appendicitis,  1. 
Females:  27  deaths;  average  age,  72  years.  Primary  seat  of  growth: 
nose,  8;  cheek,  7;  face,  3;  eye,  3;  scalp,  2;  lip,  ear,  forehead  and 
parotid  glands,  1  each.  Probable  cause:  lupus,  growth  on  ear,  pick- 
ing of  face,  trauma  and  ulcer  of  nose,  1  each.  Personal  history: 
tuberculosis,  2;  alcoholism,  1. 

Cancer  of  the  Stomach.  Males:  281  deaths;  average  age,  63  years. 
Primary  seat  of  growth:  stomach,  263;  oesophagus,  5;  intestines,  3; 
spine,  liver,  nose,  kidney,  abdomen,  rectum,  lip,  pancreas,  penis  and 
testicle,  1  each.  Probable  cause:  ulcer  of  stomach,  50;  trauma,  19; 
gastritis,  3;  overeating,  1;  cancer  of  hip,  1.  Personal  history: 
alcoholism,  48;  tuberculosis,  5;  syphilis,  5;  indigestion,  3;  stomach- 
trouble,  2;  gall-stones,  cirrhosis  of  liver,  enlarged  prostate,  hepatitis, 
lead-colic,  jaundice  and  hydrocele,  1  each.  Females:  326  deaths; 
average  age,  64  years.  Primary  seat  of  growth:  stomach,  284; 
breast,  22;  uterus,  3;  intestines,  face  and  gall-bladder,  2  each;  liver, 
hernia,  forehead,  eye,  kidney,  mesentery,  spleen,  nose,  pancreas, 
pharynx  and  ovary,  1  each.  Probable  cause:  ulcer  of  stomach,  49; 
childbirth,  17;  trauma,  8;  alcoholism,  4;  gall-stones,  2;  removal  of 
breast,  2;  ulcer  of  leg,  hernia,  cancer  of  breast,  removal  of  kidney 
and  hysterectomy,  1  each.  Personal  history:  indigestion,  15; 
tuberculosis,  7;  gastritis,  2;  typhoid  fever,  2;  uterine  fibroid,  1; 
syphilis,  1. 

Cancer  of  the  Throat.  Males:  16  deaths;  average  age,  66  years.  Primary 
seat  of  growth:  tongue,  3;  lip,  3;  larynx,  3;  maxilla,  2;  tonsil,  palate, 

119 


THE  MORTALITY  FROM  CANCER 

cheek,  oesophagus  and  pharynx,  1  each.  Probable  cause:  pipe,  7; 
ulcerated  tooth,  2;  trauma,  1.  Personal  history:  alcoholism,  5; 
syphilis,  1.  Females:  5  deaths;  average  age,  62  years.  Primary 
seat  of  growth:  larynx,  2;  tonsil,  oesophagus  and  thyroid,  1  each. 

Cancer  of  the  Tongue.  Males:  23  deaths;  average  age,  68  years.  Primary 
seat  of  growth:  tongue,  18;  lip,  2;  maxilla,  1;  tonsil,  1;  not  stated,  1. 
Probable  cause:  smoking,  12;  irritation  from  tooth,  3.  Personal 
history:  alcoholism,  6;  syphihs,  1.  Females:  4  deaths,  average  age, 
55  years.  Primary  seat  of  growth:  tongue,  jaw,  tonsil  and  not 
stated,  1  each.     Probable  cause:  smoking,  1. 

Cancer  of  the  Uterus.  401  deaths;  average  age,  55  years.  Primary  seat 
of  growth:  uterus,  374;  ovaries,  5;  breast,  2;  intestines,  2;  round 
ligament,  1;  not  stated,  17.  Probable  cause:  cervical  tear,  141; 
childbirth,  54;  ulcer  of  uterus,  5;  fibroid  uterus,  4;  trauma,  2; 
ovarian  cyst,  previous  cancer  and  vaginal  irritation,  1  each.  Per- 
sonal history:  syphilis,  10;  tuberculosis,  7;  alcoholism,  4;  uterine 
prolapse,  4;  gonorrhoea,  2;  pelvic  disease,  2;  salpingitis,  uterine 
laceration,  cancer  of  breast,  gall-stones,  vaginal  fistula,  gastric 
ulcer  and  endometritis,  1  each. 

Cancer  of  the  Vagina.  11  deaths;  average  age,  59  years.  Primary 
seat  of  growth:  vagina,  9;  uterus,  2.  Probable  cause:  vaginal 
ulcer,  operation  on  uterus,  childbirth,  tumor  and  irritation  from 
pessary,  1  each.    Personal  history :  alcohoUsm,  1 ;  syphilis,  1. 

Primary  Seat  of  Growth  and  Other  Organs  and  Parts  Involved 

The  primary  organs  or  parts  affected  and  the  number  of  other  organs 
and  parts  involved,  according  to  sex,  for  the  principle  organs  and  parts, 
according  to  the  New  York  State  investigation,  were  as  follows : 

Cancer  of  the  Bladder.  Males:  32  deaths.  Other  involvements:  ab- 
domen, 1;  pancreas,  1;  prostate,  3;  rectum,  1.  Females:  18  deaths. 
Other  involvements:  abdomen,  inguinal  gland,  intestines  and 
urethra,  1  each;  uterus,  2. 

Cancer  of  the  Breast.  Males:  5  deaths.  Other  involvements:  liver,  1. 
Females:  314  deaths.  Other  involvements:  arm,  3;  axilla,  5; 
cevxical  glands,  kidney,  larynx,  shoulder,  skin  and  uterus,  1  each; 
intestines,  2;  liver,  15;  lung,  12;  mediastinum  and  pleura,  4  each; 
neck  and  vertebra,  3  each;  stomach,  11. 

Cancer  of  the  External  Female  Generative  Organs.  16  deaths.  Other  in- 
volvements: bladder,  glandular,  liver,  pehdc  organs  and  not  speci- 
fied, 1  each;  inguinal  gland,  4. 

Cancer  of  the  Gall-bladder.  Males:  8  deaths.  Other  involvements: 
intestines,  1;  liver,  6.  Females:  24  deaths.  Other  involvements: 
intestines  and  stomach,  2  each;  liver,  12. 

Cancer  of  the  Intestines.  Males:  75  deaths.  Other  involvements: 
bladder,  peritoneum  and  stomach,  1  each;  liver,  5.  Females:  166 
deaths.  Other  involvements:  abdomen,  femur,  liver,  mediastinum 
and  ovaries,  1  each ;  bladder  and  rectum,  2  each;  stomach,  7;  uterus,  4. 

120 


CANCER  THROUGHOUT  THE  WORLD 

Cancer  of  the  Liver.  Males:  89  deaths.  Other  involvements:  intestines, 
pancreas,  rectum,  spleen,  testis  and  thorax,  1  each;  stomach,  5. 
Females:  184  deaths.  Other  involvements:  brain,  lung,  pancreas, 
peritoneum  and  uterus,  1  each;  breast,  4;  gall-bladder,  3;  intestines, 
13;  stomach,  5. 

Cancer  of  the  Lungs.  Males:  6  deaths.  Other  involvements:  lower  ex- 
tremity, stomach  and  thorax,  1  each.  Females:  11  deaths.  Other 
involvements:  axilla,  mediastinum,  pleura  and  spleen,  1  each; 
breast,  3. 

Cancer  of  the  Month.  Males:  8  deaths.  Other  involvements:  jaw  and 
stomach,  1  each;  throat,  3.  Females:  1  death.  Other  involve- 
ments: antrum,  1. 

Cancer  of  the  Ovaries.  21  deaths.  Other  involvements:  intestines,  4; 
pelvic  organs  (not  specified),  pleura,  rectum  and  uterus,  1  each. 

Cancer  of  the  Pancreas.  Males:  18  deaths.  Other  involvements:  in- 
testines, spleen  and  stomach,  1  each;  liver,  2.  Fetnales:  !24  deaths. 
Other  involvements:  gall-bladder,  intestines,  liver  and  stomach,  1 
each. 

Cancer  of  the  Rectum.  Males:  56  deaths.  Other  involvements:  bladder 
and  intestines,  3  each;  liver,  2.  Females:  48  deaths.  Other  in- 
volvements :  bladder,  2 ;  breast,  intestines,  liver,  pelvis,  peritoneum, 
stomach  and  vagina,  1  each. 

Cancer  of  the  Skin.  Males:  5Q  deaths.  Other  involvements:  eye,  in- 
testines, neck,  prostate  gland  and  throat,  1  each.  Females:  27 
deaths.     Other  involvements :  eye  and  throat,  1  each. 

Cancer  of  the  Stomach.  Males:  281  deaths.  Other  involvements:  in- 
testines, 5;  Kver,  26;  neck,  1;  oesophagus  and  pancreas,  2  each. 
Females:  326  deaths.  Other  involvements:  breast,  lung,  pancreas 
and  pelvic  organs  (not  specified),  1  each;  femur  and  intestines,  2 
each;  liver,  21;  uterus,  3. 

Cancer  of  the  Tongue.  Males:  23  deaths.  Other  involvements:  jaw  and 
mouth,  1  each;  pharynx  and  throat,  2  each.  Females:  4  deaths. 
Other  involvements :  mouth  and  skin,  1  each. 

Cancer  of  the  Uterus.  401  deaths.  Other  involvements:  abdomen,  2; 
bladder  and  ovaries,  5  each;  breast,  external  female  organs  of 
generation,  kidney  and  throat,  1  each;  intestines,  liver  and  pelvis,  3 
each;  rectum,  9;  stomach,  7. 

Cancer  of  the  Vagina.  11  deaths.  Other  involvements:  ovaries  and 
rectum,  1  each;  pelvis,  2;  uterus,  3. 

The  results  of  this  investigation  are  for  the  time  being  of  limited  value, 
on  account  of  the  paucity  of  the  data  considered;  but  the  method  em- 
ployed suggests  the  direction  which  inquiries  of  this  kind  should  take  to 
establish  with  greater  accuracy  certain  special  but  fundamental  numer- 
ical facts  of  the  cancer  problem.* 

*The  blank  used  by  the  New  York  State  Institute  for  the  Study  of  Malignant  Disease  is  given  in  Appen- 
dix B.  All  the  obseri'ations  and  conclusions  regarding  the  data  collected  by  the  New  York  State  Institute 
for  the  Study  of  Malignant  Disease  are  based  upon  this  analysis,  made  under  my  personal  direction,  of  the 
original  records  loaned  for  this  purpose  by  the  Institute  through  the  kindness  of  Dr.  H.  R,  Gaylord 
and  his  associates. 

121 


THE  MORTALITY  FROM  CANCER 

Geographical  Pathology  of  Cancer  by  Organs  and  Parts 
The  cancer  death  rate  varies  so  widely  throughout  the  civihzed  world 
that  the  argument  is  frequently  advanced  that  the  rate  of  frequency  is 
primarily  determined  by  the  accuracy  and  completeness  of  death  regis- 
tration; in  other  words,  a  low  cancer  death  rate  is  assumed  to  be  evidence 
rather  of  a  backward  state  of  medical  practice  or  a  disregard  of  funda- 
mental requirements  in  the  registration,  tabulation  and  analysis  of  vital 
statistics.  Yet  it  is  perfectly  well  known  that  certain  forms  of  cancer 
prevail  in  some  parts  of  the  world  which  are  practically  unknown  in  other 
parts  and  that  certain  types  of  malignant  disease  are  quite  common  in 
certain  occupations  and  absolutely  unknown  in  others.  It  is,  therefore, 
a  valid  assumption  that  there  may  be  local  reasons  for  cancer  rarity  or 
cancer  frequency,  irrespective  of  the  always  important  question  as  to 
whether  the  registration  of  deaths  is  both  accurate  and  complete. 
Kangri  cancer  is  practically  unknown  outside  of  a  comparatively  circum- 
scribed area  of  Asia;  cancer  of  the  cheek,  attributed  to  the  chewing  of 
the  betel  nut,  is  extremely  rare  outside  of  India;  cancer  of  the  male 
generative  organs  is  common  in  that  country,  but  very  rare  in  Europe  and 
America;  chimney-sweeps'  cancer  is  practically  limited  to  the  IJnited 
Kingdom;  Roentgen-ray  cancer  is  entirely  limited  to  X-ray  workers,  etc. 
These  forms  of  cancer  are  all  comparatively  easy  of  accurate  diagnosis, 
but  they  forcibly  emphasize  the  conclusion  that  not  only  is  cancer 
invariably,  to  begin  with,  a  strictly  local  affection,  but  that  certain 
forms  and  possibly  all  types  of  malignant  disease  may  be  determined 
by  local  conditions,  or  what  is  generally  comprehended  under  the  term 
environment.  There  are  no  reasons  known  why  cancer  should  not  be 
comparatively  rare  among  native  races;  but  many  reasons  exist  why 
cancer  should  be  relatively  common  among  the  peoples  of  civilized 
nations,  living  more  or  less  under  artificial  conditions  of  existence.  A 
low  cancer  death  rate  is,  therefore,  not  an  inherent  improbability  or 
necessarily  evidence  of  faulty  diagnosis  or  imperfect  death  registration. 
The  statistical  evidence  in  support  of  this  conclusion  is  extremely  in- 
teresting and,  as  far  as  known,  the  facts  have  not  heretofore  been 
brought  together  in  a  convenient  form.* 

A  comparative  study  in  detail  of  the  geographical  pathology  of  cancer 
throughout  the  world,  by  specified  organs  and  parts  of  the  body,  would 
be  impracticable  and  possibly  inconclusive  at  the  present  time.  The 
returns  for  certain  organs  and  parts,  however,  are  quite  comparable  for 
the  principal  countries  of  the  world,  and  for  the  present  purpose,  cancer 
of  the  stomach,  including  the  liver  and  the  oesophagus,  cancer  of  the 
skin,  cancer  of  the  female  generative  organs  and  of  the  female  breast 
have  been  selected  to  illustrate  the  wide  range  in  variation  of  cancer 

*As  an  additional  illustration  of  the  relatively  higher  degree  of  cancer  frequency  among  the  well-to-do, 
reference  may  be  made  to  the  recently  published  statistics  of  the  city  of  Edinburgh,  Scotland.  Grouping 
the  deaths  from  cancer  and  from  tuberculosis  according  to  the  rental  paid  for  the  houses  in  which  the  deaths  oc- 
curred, it  appears  that  as  regards  cancer  35.9  per  cent,  of  the  deaths  occurred  in  houses  with  the  highest  rental 
(over  $100  a  year),  37  per  cent,  occurred  in  the  houses  with  the  moderate  rental  ($50  to  $100  a  year)  and  21.8 
per  cent,  occurred  in  the  houses  with  the  lowest  rental  (less  than  $50  a  year).  In  contrast,  the  distribution  of 
deaths  from  tuberculosis,  which  is  largely  a  disease  of  poverty,  was  as  follows :  17.9  per  cent,  of  the  deaths 
occurred  in  the  houses  with  the  highest  rental  ;  34.6  per  cent,  in  the  houses  with  the  moderate  rental,  and  36.4 
per  cent,  in  the  houses  with  the  lowest  rental ;  in  other  words,  over  one-third  of  the  cancer  deaths  occurred 
among  the  well-to-do,  against  less  than  one-fifth  of  the  deaths  from  tuberculosis  among  this  class.  The  data 
emphasize  the  practical  utility  of  further  statistical  research  of  the  relation  of  housing  and  economic  condi- 
tions to  cancer  frequency. 

122 


CANCER  THROUGHOUT  THE  WORLD 

frequency,  according  to  organs  and  parts,  and  their  effect  upon  the 
general  cancer  death  rate  without  such  reference  to  the  part  of  the  body 
affected  by  mahgnant  growth.  The  specific  cancer  death  rates  have  been 
calculated  upon  an  average  population  for  not  less  than  five  years,  end- 
ing, unless  otherwise  stated,  with  1910.  The  mortality  from  cancer  of  the 
stomach,  liver  and  oesophagus  and  from  the  skin  are  given  for  both  sexes 
combined;  but  for  cancer  of  the  female  generative  orgaas  and  of  the 
female  breast  the  rates  are  based  upon  the  female  population  only. 

The  relative  frequency  of  cancer  of  the  stomach,  liver  and  oesophagus, 
combined,  for  thirteen  of  the  principal  countries  of  the  world  is  shown  in 
the  following  table,  according  to  which,  the  highest  rate  for  this  form  of 
cancer  prevailed  in  Switzerland,  or  70.4  per  100,000  of  population,  and 
the  lowest  in  Cuba,  or  only  12.7.  The  United  States  occupies  quite  a 
favorable  position,  with  a  rate  of  only  28.3. 

Comparative  Frequency  of  Cancer  of  the  Stomach,  Liver  and  Oesophagus 
in  Thirteen  Countries  of  the  World,  1906-1910 
Rate  per  100,000  of  Population 

Switzerland 70.4         Uruguay 35.6 

Holland 62.2        England  and  Wales 31.4 

Norway 61.4         Ireland 31.0 

Bavaria 59.4         United  States  Registration  Area 28.3 

Japan* 40.0         Australian  Commonwealthf 27.4 

Scotland 36.0         Italy 26.2 

♦1909-1910.  Cubaf 12.7 

tl908-1912. 

The  international  contrast  presented  by  this  table  is  one  of  unusual 
interest.  Cancer  of  the  stomach,  liver  and  oesophagus,  combined,  causes 
from  30  to  60  per  cent,  of  the  mortality  due  to  cancer  of  all  organs  and 
parts.  If  the  theory  is  sound  that  erroneous  diagnosis  primarily  deter- 
mines a  low  cancer  death  rate,  then  it  would  seem  that  considering  cancer 
of  the  stomach  and  adjacent  organs  or  parts  strictly  within  the  inaccessi- 
ble group,  diagnosis  must  be  erroneous  to  a  large  extent  in  countries  which 
have  otherwise  a  high  and  well-deserved  reputation  for  medical  and 
surgical  skill.  It  is  shown,  for  illustration,  by  the  preceding  table  that 
the  relative  mortality  from  cancer  of  the  stomach,  Hver  and  oesophagus 
was  higher  in  Uruguay  and  Japan  than  in  the  United  States  Registration 
Area  and  England  and  Wales!  Furthermore,  it  is  brought  out  that  the 
rate  for  this  group  of  cancers  was  more  than  twice  as  high  in  Switzer- 
land, Holland,  Norway  and  Bavaria  as  in  the  United  States  Registration 
Area !  It  would  certainly  seem  to  be  going  too  far  to  maintain  that  the 
practice  of  medicine  or  the  development  of  diagnostic  skill  or  the 
accuracy  of  death  certification  is  so  considerably  superior  in  Uruguay, 
Japan,  Bavaria,  Norway,  Holland  and  Switzerland  as  to  account  for 
the  wide  disparity  between  the  recorded  mortality  from  cancer  of  the 
stomach  and  adjacent  parts  in  these  countries  and  the  United  States, 
Australia  and  Italy. 

An  equally  interesting  though  less  striking  comparison  is  presented 
in  the  next  table,  for  cancer  of  the  skin.  This  comparison  is  limited  to 
eleven  countries,  since  the  returns  could  not  be  obtained  for  Norway  and 
Italy. 

123 


THE  MORTALITY  FROM  CANCER 

Comparative  Frequency  of  Cancer  of  the  Skin  in 
Eleven  Countries  of  the  World,  1906-1910 
Rate  per  100,000  of  Population 


United  States  Registration  Area 2.7         Switzerland 1.9 

Ireland 2.7        Scotland 1.7 

Australian  Commonwealth* 2.3         Holland 1.4 

England  and  Wales 2.1         Uruguay 1.1 

Cuba* 2.0        Bavaria 0.8 

*1908-1912.     tl909-1910- Japanf 0.7 

The  highest  recorded  mortahty  from  cancer  of  the  skin,  2.7  per  100,000 
of  population,  is  for  the  United  States  Registration  Area  and  Ireland, 
followed  by  a  rate  of  2.3  for  the  Australian  Commonwealth,  2.1  for 
England  and  Wales,  2.0  for  Cuba  and  1.9  for  Switzerland.  The  lowest 
rate  for  this  form  of  cancer,  0.7,  prevailed  in  Japan;  the  rate  in  Bavaria, 
was  0.8,  and  in  Uruguay,  1.1.  When  the  argument  in  regard  to 
erroneous  diagnosis  as  measured  by  a  low  recorded  cancer  death  rate  is 
applied  to  cancer  of  the  skin,  it  would  appear  that  Scotland,  Switzerland 
and  Japan  occupy  a  distinctly  unfavorable  position  as  regards  accessible 
cancer,  but  a  decidedly  favorable  one  as  regards  the  apparent  efficiency 
in  the  diagnosis  of  the  inaccessible  forms  of  cancer  of  the  stomach,  liver 
and  oesophagus.  Such  a  conclusion  requires  only  to  be  stated  to 
emphasize  its  inherent  improbability. 

The  same  method  of  reasoning  can  be  successfully  applied  to  the  two 
forms  of  cancer  most  common  to  women,  that  is,  cancer  of  the  generative 
organs  and  of  the  breast.  The  former  is  largely  internal  or  inaccessible, 
whereas  the  latter  is  among  the  most  conveniently  accessible  and  easily 
diagnosed  forms  of  malignant  disease.  The  comparative  frequency  of 
cancer  of  the  female  generative  organs  for  thirteen  of  the  principal 
countries  is  shown  in  the  following  table: 

Comparative  Frequency  of  Cancer  of  the  Female  Generative  Organs 

in  Thirteen  Countries  of  the  World,  1906-1910 

Rate  per  100,000  of  Female  Population 

England  and  Wales 24.2  Cubaf 18.9 

United  States  Registration  Area 22.1  Italy 16.0 

Bavaria 21.6  Australian  Commonwealthf 15.5 

Switzerland 21.4  Holland 13.2 

Japan* 20.9  Ireland 12.8 

Scotland 20.6  Uruguay 12.2 

*1909-1910.     ti908-i9i2. Norway 1 1 .5 

The  highest  rate  for  cancer  of  the  female  generative  organs  in  the 
group  of  countries  represented  in  the  table  is  shown  to  prevail  in  Eng- 
land and  Wales,  or  24.2,  followed  by  the  United  States  Registration  Area 
with  a  rate  of  22.1,  and  Bavaria  with  21.6.  The  lowest  rates  are  shown 
to  prevail  in  Norway,  11.5,  Uruguay,  12.2,  and  Ireland,  12.8.  In  the 
comparative  table  for  cancer  of  the  stomach,  liver  and  oesophagus,  the 
Norwegian  rate  was  the  third  highest,  whereas  in  the  present  comparison 
the  rate  for  Norway  is  the  lowest  of  the  thirteen  countries  repre- 
sented. If,  therefore,  the  argument  were  sound  that  a  low  cancer  death 
rate  must  be  considered  evidence  of  imperfect  diagnostic  skill  or  defec- 
tive methods  of  death  registration,  Norway  would  rank  first  in  regard  to 
the  diagnosis  of  cancer  of  the  stomach,  liver  and  oesophagus,  and  last  in 

124 


CANCER  THROUGHOUT  THE  WORLD 

regard  to  the  diagnosis  of  cancer  of  the  female  generative  organs.  The 
same  conclusion  would  apply  to  Holland.  It  would  further  follow  that 
since  the  rate  for  Scotland  was  20.6  and  for  Japan  20.9,  the  diagnosis 
of  cancer  of  the  female  generative  organs  was  about  equally  well  devel- 
oped in  these  two  countries;  but  as  subsequently  shown,  this  con- 
clusion would  not  hold  at  all  for  the  much  more  easily  diagnosed 
form  of  cancer  of  the  female  breast.  The  comparative  frequency  rates 
for  cancer  of  the  female  breast  for  thirteen  representative  countries  of 
the  world  are  given  in  the  table  following: 

Comparative  Frequency  of  Cancer  of  the  Female  Breast  in  Thirteen 

Countries  of  the  World,  1906-1910 

Rate  per  100,000  of  Female  Population 

England  and  Wales 17.9         Holland 9.6 

Scotland 15.4         Bavaria 9.1 

Ireland 14.0         Norway 7.3 

Switzerland 13.6         Italy 5.8 

United  States  Registration  Area 13.3         Cuba* 4.5 

Australian  Commonwealth* 10.6         Uruguay 3.7 

*1908-1912.     ti909-19l0. Japanf 1.8 

The  highest  frequency  rate  for  cancer  of  the  female  breast  of  the 
thirteen  countries  included  in  the  comparison  prevailed  in  England  and 
Wales,  the  rate  being  17.9.  The  next  highest  rate,  15.4,  prevailed  in 
Scotland,  followed  by  a  rate  of  14.0  for  Ireland,  of  13.6  for  Switzerland  and 
of  13.3  for  the  United  States  Registration  Area.  The  lowest  rate  prevailed 
in  Japan,  being  only  1.8,  followed  by  3.7  for  Uruguay,  4.5  for  Cuba,  5.8  for 
Italy  and  7.3  for  Norway.  The  rate  for  Italy  of  5.8  is  less  than  one-half 
the  rate  of  13.3  for  the  United  States  Registration  Area. 

For  cancer  of  the  female  generative  organs  the  rates  are  not  far  apart 
for  England  and  Japan,  whereas  for  cancer  of  the  female  breast  the 
English  rate  is  nearly  ten  times  the  recorded  rate  for  Japan*  It  thus 
appears  that  the  two  forms  of  cancer  diagnosed  with  difficulty,  on 
account  of  inaccessibility,  that  is,  cancer  of  the  stomach,  liver  and 
oesophagus  and  cancer  of  the  female  generative  organs,  are  diagnosed  as 
well,  or  even  better,  in  Japan  as  in  England  and  Wales,  whereas  the 
two  most  accessible  forms  of  cancer,  i.  e.,  cancer  of  the  skin  and  of  the 
female  breast,  are  apparently  diagnosed  with  a  much  lesser  degree  of 
accuracy  in  Japan  than  in  England  and  Wales.  This  conclusion  requires 
only  to  be  stated  to  bring  out  its  inherent  improbability,  and  yet,  by 
inference,  the  same  argument  applies  to  the  broad  generalizations  in 
regard  to  the  crude  cancer  death  rate  without  reference  to  organs  or 
parts,  which  for  the  present  purpose,  however,  has  been  subjected  to 
further  analysis,  to  establish  the  fundamental  truth  that  the  local  variations 
in  cancer  frequency  throughout  the  world  are  primarily  conditioned  by  local 
causes  and  not  by  faulty  methods  of  diagnosis  or  defective  methods  of  death 
registration.  The  statistical  data  upon  which  these  conclusions  are 
based  are  given  in_  Table  4,  Appendix  E,  which  will  facilitate  the 
further  study  of  this  important  phase  of  the  cancer  problem. 

*During  a  visit  to  Hawaii  I  made  careful  inquiry  among  practically  all  the  leading  physicians  regarding 
the  occurrence  of  cancer  of  the  breast  among  Japanese  women,  and  the  answer  was  invariably  to  the  same 
effect,  that  this  form  of  malignant  disease  was  extremely  rare  among  them.  The  number  of  Japanese  women 
ages  25  and  over  in  Hawaii  in  1910  was  11,802.  Out  of  33  deaths  from  cancer  among  the  Japanese  of 
both  sexes  during  the  two  years  ending  June  30,  1913.  not  a  single  death  was  from  cancer  of  the  breast. 

125 


CHAPTER  VII 

THE  STATISTICAL  DATA  OF  CANCER  FREQUENCY  IN 
AMERICAN  STATES  AND  CITIES 

Limitations  of  Crude  Statistics — Progressive  Increase  in  the  Cancer  Death  Rate — Mor- 
tality in  Large  American  Cities — Sources  of  Errors — Range  in  Cancer  Death  Rates — 
Comparative  Mortality  Rates  by  Organs  and  Parts — Comparative  Mortality  Rates 
by  Age,  Sex  and  Race — Cancer  among  Mexicans. 

The  geographical  distribution  of  cancer  throughout  the  United  States 
by  separate  states  and  cities  is  presented  in  185  tables.  All  of  these 
have  been  derived  from  official  sources,  and  as  far  as  practicable  they 
have  been  made  to  include  the  essential  details  of  sex,  race  and  organs 
and  parts  of  the  body  affected.  For  many  states  and  cities  this  in- 
formation in  detail  is  not  available,  but  sufficient  data  have  been  brought 
together  to  establish  the  salient  statistical  facts  of  the  cancer  mortality 
problem  in  the  United  States  at  the  present  time.  As  a  rule,  the  statistics 
have  not  been  carried  further  back  than  1871,  since  for  most  of  the 
cities  the  data  are  available  only  for  comparatively  recent  periods.  The 
statistics  by  states  are  limited  to  the  New  England  States,  New  York 
and  New  Jersey,  and  a  table  is  included  presenting  the  combined  mor- 
tality for  this  group  of  states  since  1886  (Table  21,  Appendix  F,  Part  2). 
For  Massachusetts,  however,  the  returns  are  given  since  1856,  so  as  to 
facilitate  the  historical  study  of  the  cancer  problem  by  means  of  data 
which  are  generally  accepted  as  approximately  correct  for  the  earlier 
period. 

The  statistics  for  forty-one  American  cities  are  sufficient  to  emphasize 
the  great  practical  importance  of  cancer  as  an  urban  mortality  problem. 
For  certain  cities  the  available  information  is  naturally  much  more 
complete  than  for  others ;  but  it  would  have  unduly  enlarged  this  work 
and  the  necessary  discussion  if  all  the  available  facts  of  cancer  mortality, 
by  organs  and  parts  as  well  as  by  age,  sex  and  race,  had  been  given  in  full 
for  the  large  number  of  American  cities  which  in  1910  had  a  population 
of  30,000  or  more.  The  information  omitted  would  have  been  largely 
cumulative  evidence,  and  though  useful  for  local  purposes  of  cancer 
research,  it  would  obviously  be  a  practical  impossibility  to  include  in  a 
work  of  this  kind  the  entire  statistical  material  of  cancer  mortality, 
not  only  of  the  United  States  and  its  subdivisions,  but  also  of  all  the 
other  countries  of  the  world.  It  would  have  been  even  more  difficult, 
if  not  impossible,  to  briefly  and  accurately  summarize  and  discuss  the 
large  amount  of  statistical  material  presented  in  tabular  form  for  pur- 
poses of  convenient  reference  and  further  study  and  research. 

Limitations  of  Crude  Statistics 
There  are  also  many  practical  limitations  which  affect  the  correct 
interpretation  of  crude  local  cancer  death  rates.  All  such  data,  unless 
standardized  for  age  and  sex,  require  to  be  used  with  caution  in  efforts  to 
illustrate  the  comparative  frequency  or  infrequency  of  cancer  in  the  differ- 
ent sections  or  cities  of  the  United  States.    Occasionally  large  institutions, 

126 


AMERICAN  CANCER  STATISTICS 

such  as  hospitals,  almshouses,  asyhims  for  the  insane,  soldiers'  homes, 
etc.,  substantially  increase  the  local  cancer  death  rate,  which  in  such 
cases  requires  to  be  standardized,  at  least  for  age,  if  misleading  conclu- 
sions are  to  be  avoided.  When  due  allowance,  however,  is  made  for  all 
the  factors  which  affect  the  practical  utility  and  accuracy  of  cancer  mor- 
tality statistics,  there  remains  no  question  of  reasonable  doubt  that  on 
the  whole  the  available  data  are  fairly  comparable  and  that  they  are  an 
approximately  accurate  indication  of  local  variations  in  cancer  frequency. 

Progressive  Increase  in  the  Cancer  Death  Rate 

Considering,  first,  the  combined  cancer  mortality  statistics  of  the  New 
England  States  and  New  York  and  New  Jersey  since  1886,  the  data  are 
set  forth  with  the  required  brevity  in  the  following  table,  by  quinquen- 
nial periods  down  to  1910  and  thereafter  by  single  years. 

Mortality  from  Cancer  in  the  New  England  States,  New  York  and 
New  Jersey,  1886-1913 


Deaths 

Rate  per 

Relative  Rate 

Years 

Population 

from 

100,000 

1886-1890 

Cancer 

Population 

Being  100 

1886-90 

55,320,449 

26,215 

47.4 

100.0 

1891-95 

64,879,439 

34,536 

53.2 

112.2 

1896-00 

71,405,669 

44,645 

62.5 

131.9 

1901-05 

78,132,762 

55,501 

71.0 

149.8 

1906-10 

87,343,060 

69,140 

79.2 

167.1 

1911 

18,699,051 

15,980 

85.5 

180.4 

1912 

18,976,968 

16,640 

87.7 

185.0 

1913 

19,327,238 

17,385 

90.0 

189.9 

The  progressive  increase  in  the  cancer  death  rate  of  a  large  and  con- 
tiguous area  in  the  United  States  is  concisely  shown  by  this  table. 
The  details  by  single  years  are  given  in  Table  21,  Appendix  F,  Part  2. 
The  average  cancer  death  rate  of  this  area,  which  in  1913  contained  a 
population  of  more  than  19,000,000,  has  increased  from  47.4  during  the 
five  years  ending  with  1890  to  79.2  during  1906-10  and  to  90.0  during  the 
year  1913.  A  similar  upward  tendency  of  the  cancer  death  rate  is 
disclosed  by  the  combined  experience  of  twenty  large  American  cities 
since  1881,  which  in  1913  had  a  population  of  13,400,000.  A  sum- 
mary of  the  data  is  given  in  the  table  below : 

Mortality  from  Cancer  in  Twenty  Large  American  Cities,   1881-1913 


Deaths 

Rate  per 

Relative  Rate 

Years 

Population 

from 

100,000 

1886-1890 

Cancer 

Population 

Being  100 

1881-85 

30,328,347 

14,735 

48.6 

95.9 

1886-90 

35,302,944 

17,884 

50.7 

100.0 

1891-95 

40,912,510 

22,513 

55.0 

108.5 

1896-00 

47,016,267 

28,533 

60.7 

119.7 

1901-05 

53,386,935 

37,127 

69.5 

137.1 

1906-10 

60,116,913 

47,701 

79.3 

156.4 

1911 

12,849,687 

10,713 

83.4 

164.5 

1912 

13,125,121 

11,203 

85.4 

168.4 

1913 

13,400,553 

11,971 

89.3 

176.1 

127 


THE  MORTALITY  FROM  CANCER 

According  to  this  table  and  the  details  by  single  years,  as  given  in 
Table  22,  Appendix  F,  Part  2,  the  cancer  death  rate  of  twenty  large 
American  cities  increased  from  an  average  rate  of  50.7  during  the  five 
years  ending  with  1890  to  79.3  during  the  five  years  1906-10  and,  fur- 
ther still,  to  85.4  during  the  year  1912  and  to  89.3  during  the  year  1913. 
Cancer  Mortality  of  Southern  Cities 

In  Southern  cities  the  cancer  death  rate  of  the  white  population  in- 
creased from  an  average  of  52.7  during  the  period  1891-95  to  96.6  in  1913. 
The  corresponding  increase  in  the  negro  cancer  death  rate  during  this 
period  was  from  39.1  to  73.5.  The  relative  increase  in  the  rate  for  the 
white  population  of  Southern  cities  was  83.3  per  cent.,  in  comparison 
with  an  increase  of  88.0  per  cent,  for  the  negro  population.* 
Mortality  of  Large  American  Cities 

In  the  table  following,  the  principal  American  cities  for  which  the  infor- 
mation is  available  are  arranged  in  the  order  of  their  recorded  cancer  mor- 
tality frequency  for  the  five-year  period  ending  with  1910.  The  details  for 
these  cities  are  given  in  Appendix  F,  Part  2,  and  it  is  only  necessary  to  call 
special  attention  to  the  fact  that,  on  account  of  their  local  importance,  the 
two  subdivisions  of  the  combined  Boroughs  of  Manhattan  and  Bronx  and 
of  Brooklyn  have  been  included,  in  addition  to  the  rate  for  Greater 
New  York. 

Cancer  Mortality  Rates  of  American  Cities,  1906-1910 
Rates  per  100,000  of  Population 


City 


Average  Rate 


City 


Average  Rate 


San  Francisco 102.5 

Boston 99.4 

Providence 96.9 

Los  Angeles 94.9 

Cincinnati 93.0 

Hartford 91.9 

New  Haven 89.8 

Dayton 88.5 

Rochester 88.2 

Springfield  (Mass.) 86.9 

District  of  Columbia 86.0 

Baltimore 85.8 

Omaha 85.7 

Buffalo 84.0 

New  Orleans 82.2 

Philadelphia 81.9 

Hoboken 80.7 

Columbus 79.5 

Boro,  of  Manh.  and  Bronx .  .  78.4 

St.  Louis 78.4 

Denver 77.9 


Newark 76.9 

Chicago 76.5 

Greater  New  York 74.1 

Richmond 73.9 

Kansas  City  (Mo.) 71.1 

St.  Paul 71.1 

Indianapolis 70.4 

Boro.  of  Brooklyn 68.9 

Milwaukee 68.4 

Nashville 68.0 

Pittsburgh 66.4 

Minneapolis 65.3 

Detroit 64.5 

Cleveland 62.9 

Louisville 61.1 

Jersey  City 60.5 

Charleston 53.6 

Seattle 50.2 

Augusta  (Ga.) 49.1 

Memphis 48.7 

Savannah   47.1 


*The  ethnological  aspectsof  the  cancer  problem,  with  special  reference  to  the  American  negro,  are  briefly  dis- 
cussed in  the  third  volume  of  the  cancer  treatise  by  J.  Wolff.  The  data  used,  however,  are  inadequate  to  the  pur- 
pose. The  same  conclusion  applies  to  the  brief  references  to  the  negro  cancer  death  rate  in  the  recent  work  on  the 
cancer  problem  by  Dr.  Seaman  Bainbridge.  For  some  exceedingly  interesting  obser\THions  on  cancer  frequency 
among  the  negro  population,  see  article  by  Dr.  Rudolph  Matas  in  the  "System  of  Surgery,"  by  Dr.  Frederick  S. 
Dennis.  Also  "Observations  on  tumor  formation  in  white  and  colored  races  compared,"  by  Rudolph  Matas,  M.D., 
in  "The  Surgical  Peculiarities  of  the  American  Negro,"  Transactions  of  the  American  Surgical  .Association,  1896. 


128 


AMERICAN  CANCER  STATISTICS 

Sources  of  Statistical  Errors 

It  has  not  been  feasible  to  standardize  these  rates  for  variations  in  the 
age  and  sex  distribution  of  the  populations.  The  liability  to  error  in  this 
respect  is  less  serious  than  the  local  increase  in  cancer  death  rates  result- 
ing from  admissions  to  hospitals  of  cancer  patients  from  surrounding 
and  even  remote  localities.*  It  is  unfortunate  that  at  the  present  time 
such  deaths  are  not  redistributed  in  the  final  tabulations  of  mortality 
according  to  the  residence  of  the  deceased.  Such  a  correction  is  par- 
ticularly called  for  in  the  case  of  cities  which  provide  exceptional  in- 
stitutional facilities  for  the  treatment  of  malignant  disease.  It,  how- 
ever, is  a  reasonably  safe  assumption  that  this  factor  of  error  is  not  of  as 
much  importance  as  is  often  assumed  to  be  the  case.f  In  a  strictly 
scientific  study  of  the  local  incidence  of  cancer  a  redistribution  of  the 
deaths  according  to  the  residence  of  the  deceased  is,  of  course,  required. 
The  present  state  of  our  American  vital  statistics,  however,  does  not 
afford  the  means  for  such  a  redistribution  in  the  general  mortality  re- 
turns, and  they  have,  therefore,  to  be  accepted  as  published,  subject  to 
the  foregoing  words  of  caution,  which  apply  to  practically  the  entire 
statistical  material  presented  in  this  work. 

A  striking  fact  disclosed  by  the  preceding  table  of  cancer  mortality 
rates  of  American  cities  is  the  wide  range  between  the  maximum  of  102.5 
for  San  Francisco  and  the  minimum  of  47.1  for  Savannah.  The  rates 
are  necessarily  affected  by  the  age  and  sex  distribution  of  the  population, 
but  for  general  purposes  they  are  useful  in  providing  an  approximate 
index  of  local  cancer  frequency.  Where  the  female  population  is  decidedly 
in  excess  of  the  male  population,  it  is  obvious  that  the  crude  death 
rate,  unless  standardized  for  sex,  would  be  misleading,  since  as  a  rule 
the  cancer  death  rate  of  males  is  considerably  below  the  cancer  death 
rate  of  females.  In  Boston,  for  illustration,  the  male  cancer  death  rate 
is  75.2,  whereas  the  cancer  death  rate  of  females  is  126.5  (Tables  35  and 
36,  Appendix  F,  Part  2).  The  same  conclusion  applies  to  the  element 
of  race,  which  in  part  accounts  for  the  relatively  low  cancer  rates  of 
certain  Southern  cities.  For  Charleston,  S.  C,  for  illustration,  the  cancer 
death  rate  of  the  white  population  is  73.2,  whereas  for  the  colored  popu- 
lation the  rate  is  only  36.6  (Tables  44  to  46,  Appendix  F,  Part  2). 
The  crude  death  rate  for  both  races  combined  is  therefore  reduced  by 
the  large  proportion  of  negro  population,  and  the  rates  are  required  to 
be  considered  separately  for  the  two  races,  if  erroneous  conclusions  are 
to  be  avoided.  It  is  hardly  necessary  to  point  out  in  this  connection 
that  the  mortality  returns  for  the  negro  population  are  intrinsically  less 
trustworthy  than  those  for  the  white  population,  in  view  of  the  relatively 
low  professional  status  of  the  negro  physicians  and  the  comparatively 
high  proportion  of  deaths  among  the  negro  population  without  proper 
medical  attendance. 

Comparative  Cancer  Mortality  by  Organs  and  Parts  of  the  Body 

As  an  illustration  of  the  most  convenient  method  available  in  the 

*This  conclusion  applies  with  special  force  to  the  city  of  Boston,  where  the  Massachusetts  General  Hospital 
tends  to  increase  the  local  cancer  death  rate  by  the  admission  of  cancer  patients  not  only  from  the  immedi- 
ately surrounding  territory,  but  even  from  other  New  England  States  and  still  more  distant  parts  of  the 
country. 

tSee  remarks,  on  page  144,  on  Cancer  Frequency  according  to  Size  of  Cities. 

129 


THE  MORTALITY  FROM  CANCER 


comparative  study  of  cancer  frequency  by  organs  and  parts  and  according 
to  sex,  the  following  two  summary  tables  are  inserted,  for  the  city  of 
Boston  for  the  period  of  1903-12  and  the  city  of  San  Francisco  for  the 
period  1906-13. 

Mortality  from  Cancer  in  Boston,  Mass.,  by  Organs  and  Parts 
according  to  Sex,  1903-1912 


TOTAL 


Organ  or  Part 


Deaths 


Buccal  cavity 308 

Stomach  and  liver 2,027 

Peritoneum,intestines  and 

rectum 1,127 

Female  generative  organs  921 

Breast 657 

Skin 82 

Other    or    not    specified 

organs 1,318 


Rate  per 

100,000 

Population 

4.9 
31.9 

17.7 

14.5 

10.3 

1.3 

20.7 


All  organs 6,440     101.3 


MALES 

Rate  per 
Deaths    100,000 
Population 

248      8.0 
918     29.5 


446     14.3 


7 
44 


0.2 
1.4 


679     21.8 


2,342     75.2 


FEMALES 

Rate  per 

Deaths  100,000 

Population 

60  1.9 

1,109        34.2 


681 

921 

650 

38 

639 


21.0 

28.4 

20.1 

1.2 

19.7 


4,098      126.5 


Mortality    from    Cancer    in   San    Francisco,   Cal.,  by  Organs   and   Parts 
according  to  Sex,  July  1,  1906,  to  June  30,  1913 


TOTAL 

Organ  or  Part 


Deaths 


Buccal  cavity 186 

Stomach  and  liver 1,377 

Peritoneunijintestines  and 

rectum 442 

Female  generative  organs.  406 

Breast 253 

Skin ..  67 

Other    or    not    specified 

organs 468 


Rate  per 

100,000 

Population 

6.5 

48.0 

15.4 
14.2 

8.8 
2.3 

16.4 


Morgans 3,199     111.6 


MALES 

Rate  per 
Deaths     100,000 
Population 

172     10.6 

878 

54.1 

223 

13.7 

1 

o'.i 

41 

2.5 

336 

20.8 

1,651 

101.8 

FEMALES 

Rate  per 

Deaths         100,000 

Population 

14  1.1 

499         40.1 


219 
406 

252 
26 

132 


17.6 

32.6 

20.2 

2.1 

10.6 


1,548       124.3 


Inadequacy  of  Existing  Data 

It  is  regrettable  that  information  regarding  the  local  cancer  problem 
should  not  be  available  in  this  form  for  all  of  the  cities  considered. 
Obviously  the  local  study  of  cancer  in  its  final  analysis  reduces  itself 
to  the  separate  consideration  of  cancer  frequency,  by  organs  and 
parts,  according  to  sex,  race  and  age.  Such  an  extended  statistical 
analysis,  however,  results  in  extremely  complex  problems  of  the  precise 
correlation  of  the  statistical  conclusions  to  the  medical,  anthropological, 
environmental  and  even  sociological  considerations  which  affect  the 
cancer  problem.  It  will  probably  not  be  found  feasible  to  provide 
much  more  than  a  complete  statistical  analysis  of  the  cancer  mortality 


130 


AMERICAN  CANCER  STATISTICS 

of  the  larger  states  and  cities  and  of  course  for  the  registration  area 
of  the  United  States  as  a  whole.*  The  admirable  consideration  of  the 
statistical  details  of  the  cancer  problem,  with  special  reference  to  the 
requirements  of  modern  cancer  research,  in  the  Annual  Reports  of  the 
Registrar-General  for  England  and  Wales  may  be  referred  to  as  sugges- 
tive of  the  method  most  likely  to  produce  results  of  practical  utility. 
In  view  of  the  enormous  extent  to  which  minute  pathological  re- 
searches have  been  carried  in  the  more  or  less  illusive  hope  of  ascertain- 
ing a  cancer  cause  and  a  cancer  cure,  it  would  seem  but  reasonable  to 
insist  upon  more  extended  but  thoroughly  qualified  statistical  research 
than  has  heretofore  been  the  case  and  the  gradual  replacement  of  crude 
and  even  misleading  data  with  returns  of  unquestioned  accuracy  and  con- 
clusiveness made  available  for  critical  and  minute  analysis. 

Comparative  Cancer  Mortality  Rates  by  Age,  Sex  and  Race 
No  aspect  of  the  cancer  problem  from  the  statistical  point  of  view 
has  been  more  neglected  than  the  age  factor,  which  is  fundamental  in 
every  statistical  discussion  of  the  cancer  mortality  problem.  Only  a 
few  American  cities  provide  the  necessary  information  of  cancer  mortal- 
ity by  age  and  sex,  and  only  a  very  few  furnish  the  absolutely  essential 
additional  information  of  cancer  mortality  by  age,  sex  and  organs  and 
parts.  The  table  followingf  is  suggestive  of  the  practical  value  of 
statistical  analysis  of  cancer  by  age,  sex  and  race;  but  in  Appendix  F, 
Part  2,  numerous  tables  are  included  which  further  illustrate  the  age 
incidence  of  cancer  by  organs  and  parts: 

Mortality  from  Cancer  in  the  District  of  Columbia,  U.  S.  A.,  1901-1910 
by  Age,  Sex  and  Race,  Rate  per  100,000  of  Population 


WHITE 

COLORED 

Ages 

Males 

Females 

Males 

Females 

Under  10 

1.7 

0.6 
1.7 

•• 

2.7 

10-19 

4.2 

1.1 

20-29 

5.8 

3.1 

9.7 

13.1 

SO-39 

23.2 

56.0 

26.3 

72.3 

40-49 

62.5 

162.2 

48.7 

207.3 

50-59 

182.4 

347.3 

139.6 

328.9 

60-69 

413.7 

456.4 

310.1 

386.6 

70  and  over 

610.6 

556.9 

335.1 

522.1 

All  ages 

70.6 

104.8 

38.6 

86.5 

40  and  over 

217.1 

312.0 

130.2 

293.9 

The  value  of  specialized  cancer  research  has  been  well  brought  out 
by  Bashford  in  his  observations  on  the  differential  age  incidence  of 
sarcoma  and  carcinoma.  |     The  variations  in  cancer  incidence  by  age,  sex 

*Such  an  analysis  of  cancer  mortality  in  detail  is  contemplated  by  the  Division  of  Vital  Statistics  of 
the  United  States  Census  for  the  year  1914.  The  same  is  to  be  published  as  a  monograph  apart  from 
the  annual  report  on  the  mortality  of  the  registration  area  as  a  whole. 

fFor  a  more  extended  discussion  of  the  cancer  statistics  of  the  District  of  Columbia,  see  my  "Menace 
of  Cancer"  published  in  the  Transactions  of  the  American  Gynecological  Society,  1913.  (See  also  Tables  182  to 
136,  Appendix  F,  Part  2.) 

t  The  age  incidence  by  single  years  of  life  in  sarcoma  and  carcinoma  is  given  in  detail  in  the  Prudential  Indus- 
trial Mortality  Experience  data  appended  to  the  chapter  on  Cancer  as  a  Problem  in  Life  Insurance  Msdicine, 
Tables  8  to  15,  Appendix  D. 

131 


THE  MORTALITY  FROM  CANCER 

and  race,  with  particular  reference  to  organs  and  parts,  are  so  numerous, 
so  perplexing  and  so  frequently  conditioned  by  special  circumstances  that 
extreme  caution  is  invariably  necessary  in  utilizing  the  data  for  practi- 
cal purposes.  At  the  same  time,  it  would  seem  that  special  research  in 
this  direction  gives  promise  of  revealing  much  that  is  new  in  the  scientific 
study  of  the  cancer  problem;  for  there  can  be  no  serious  question  of 
doubt  that  the  variations  in  frequency  are  real  and  not  apparent,  are 
more  often  the  result  of  local  conditioning  circumstances  than  of 
errors  in  statistical  tabulation  and  analysis  or  a  matter  of  pure  chance. 
For  illustration,  almost  every  table  by  organs  and  parts  exhibits  a  dis- 
tinctly higher  mortality  of  cancer  of  the  buccal  cavity  among  males  than 
among  females  and  as  a  rule  a  higher  mortality  from  cancer  of  the  peri- 
toneum, intestines  and  rectum  among  women.  Without  exception  the 
general  cancer  mortality  in  the  United  States  is  higher  for  the  white 
population  than  for  the  negro,  regardless  of  latitude  and  longitude,  and 
the  fact  that  as  a  broad  principle  the  two  races  are  living  under  much 
the  same  conditions,  with  a  constant  approach  towards  equality  in  all 
that  ministers  to  the  needs  of  the  body,  somehow  or  in  some  way 
affects  nutrition  and  metabolism,  in  brief,  development  and  growth.* 

Cancer  among  Mexicans 

The  mortality  from  cancer  among  Mexicans  in  the  United  States 
has  not  been  made  the  subject  of  an  extended  investigation.  It  has 
seemed,  however,  advisable  for  the  present  purpose  to  make  an  original 
analysis  of  the  mortality  returns  for  San  Diego  and  Los  Angeles,  Cali- 
fornia, and  El  Paso  and  San  Antonio,  Texas,  for  the  period  1910-14. 
Out  of  2,935  deaths  of  Mexican  males,  ages  15  and  over,  91,  or  3.1  per 
cent.,  died  from  cancer.  The  corresponding  proportion  of  deaths  from 
cancer  among  2,419  Mexican  females  was  144,  or  6.0  per  cent.  At  ages 
15-44  the  proportionate  mortality  from  cancer  was  1.6  per  cent,  for 
males  and  3.7  per  cent,  for  females;  and  at  ages  45  and  over,  5.1  per 
cent,  for  males  and  9.1  per  cent,  for  females.  The  proportionate  mor- 
tality is  higher  than  expected,  considering  the  rather  simple  mode  of 
life  and  the  peculiar  diet  of  this  class  of  people.  The  Mexican  element 
of  the  southwest  is  chiefly  of  the  peon  class  with  a  fair  degree  of  inter- 
mixture with  the  Indians  of  Northern  Mexico.  For  the  City  of  Mexico 
the  average  cancer  death  rate  is  53.1,  which  compares  with  a  rate  of 
74.1  per  100,000  for  the  city  of  New  York. 

*In  this  connection  the  following  observations  and  conclusions  by  Dr.  Rudolph  Matas,  in  his  treatise  on 
"The  Surgical  Peculiarities  of  the  American  Negro,"  are  of  special  interest  and  practical  importance.  Dr. 
Matas  concludes:  "1.  That  the  tendency  to  the  formation  of  neoplastic  tissue  whether  purely  hyperplastic 
or  heteroplastic  is  greater  in  the  negro  than  in  the  white  race.  2.  That  the  typical  mesoblastic  derivatives 
of  the  adult  connective  tissue  group  are  especially  prone  to  develop  in  the  negro.  3.  That  of  this  group, 
the  fibroma  and  cicatricial  keloid  preponderate  sufficiently  to  give  to  the  black  race  a  striking  pathological 
peculiarity.  4.  That  the  mesoblastic  derivatives  of  the  embryonal  connective  tissue  type,  i.  e.,  the  sarcomata, 
are  also  apparently  more  frequent  in  the  negro  with  the  sole  exception  of  the  melanotic  sarcomas,  which 
are  rare.  6.  That  contrary  to  the  generally  accepted  belief,  the  epiblastic  derivatives  of  embryonal  type, 
or  the  true  cancers,  appear,  statistically  at  least,  to  be  even  more  common  than  in  the  white  race.  6.  That 
in  regard  to  the  malignant  neoplasms  the  negro  constitution  has  probably  undergone  some  change  under 
the  conditions  of  American  civilization,  since  it  cannot  be  doubted  that  cancer  is  comparatively  rare  in  the 
native  African,  rare  also  in  the  original  slave  population  in  this  country,  and  has  only  become  a  common 
disease  in  the  American  negro  of  the  last  few  generations.  It  is  also  probable  that  the  conditions  that  are 
causing  an  increase  in  the  prevalence  of  cancer  among  the  whites  are  also  acting  with  the  same  effect  upon 
the  negroes." 

See  also  the  consolidated  statistics  of  cancer  in  the  experience  of  the  Charity  Hospital  of  New  Orleans, 
by  race  and  organs  and  parts,  for  the  period  1908-12,  Tables  104  and  105,  Appendix  F,  Part  2. 

132 


CHAPTER  VIII 

THE  STATISTICAL  DATA  OF  CANCER  FREQUENCY  IN  FOREIGN 

COUNTRIES 

Comparative  Cancer  Mortality  Rates  for  Europe — Africa — Asia — Australasia — Western 
Hemisphere — Limitations  of  International  Statistics — Cancer  a  World-wide  Menace 
— Effect  of  Latitude  and  Longitude,  and  of  Size  of  Cities — Comparative  Death  Rates 
of  American  and  European  Cities. 

The  cancer  statistics  available  for  foreign  countries  are  of  much  the 
same  character  and  extent  as  those  available  for  the  registration  area  of 
the  United  States.  Some  of  the  returns  are  unquestionably  much  more 
trustworthy  than  others,  but  their  intrinsic  worth  can  be  determined 
only  by  precise  and  laborious  methods  of  statistical  analysis  and  medi- 
cal reconsideration  of  the  original  death  certificates.  Most  of  the 
original  sources  of  cancer  mortality  statistics  for  foreign  states  and 
cities  are  quite  difficult  of  access  to  American  students  of  the  statistical 
aspects  of  the  cancer  problem,  and  it  has  therefore  seemed  advisable  to 
give  special  consideration  to  the  statistics  of  foreign  countries  and  as  far 
as  practicable  to  those  of  every  important  geographical  subdivision  of 
the  world,  so  as  to  make  the  presentation  of  the  facts  meet  all  reason- 
able requirements.  Much  available  information  has  necessarily  been 
excluded,  since  such  data  would  rather  have  been  in  the  nature  of  cumu- 
lative evidence,  not  absolutely  essential  to  the  present  purpose,  however 
useful  the  facts  would  have  been  in  connection  with  strictly  local  cancer 
mortality  studies. 

Comparative  Cancer  Mortality  Rates  for  Europe 

The  foreign  statistics  are  given  in  Appendix  G,  and  contained  in  224 
tables  for  the  Continent  of  Europe  and  163  tables  for  non-European 
countries  other  than  the  United  States  of  America.  In  addition  there 
are  given  in  Appendix  E  4  tables  which  show  the  cancer  mortality 
according  to  latitude  and  size  of  cities  and  by  organs  and  parts  in 
thirteen  principal  countries  of  the  world.  Unless  specifically  so  stated 
all  the  information  from  which  these  tables  have  been  compiled  has 
been  derived  from  official  sources,  which  are,  as  a  rule,  indicated  in  a 
footnote  to  each  table.  A  full  discussion  of  this  vast  amount  of  statis- 
tical evidence  regarding  cancer  frequency  throughout  the  world  would 
obviously  be  an  impossible  task  in  a  work  of  this  kind.  The  main  pur- 
pose of  the  present  investigation,  as  elsewhere  stated,  has  been  and  is 
to  make  a  reasonably  large  amount  of  statistical  information  regarding 
the  cancer  problem  available  for  further  study  and  research.  The 
assembled  evidence  of  cancer  mortality  throughout  the  world  reemphasizes 
the  earlier  conclusion  that  the  disease  is  gradually  on  the  increase  in 
practically  all  civilized  countries.  For  certain  European  countries  the 
increase  by  quinquennial  periods  during  the  fifteen  years  ending  with 
1910  is  briefly  shown  in  the  table  following; 

133 


THE  MORTALITY  FROM  CANCER 

Comparative  Mortality  from  Cancer  in  European  Countries,  1896-1910 

1896-1900  1901-1905  1906-1910 

Rate  per  Rate  per  Rate  per 

100,000  100,000  100,000 

Population  Population  Population 

England  and  Wales 80.1  86.7  94.0 

Scotland 77.1  84.8  99.7 

Ireland 58.1  68.5  78.8 

Norway 85.7  94.9  96.6 

Denmark  (cities) 118.9  129.1  137.3 

German  Empire 70.8  77.7  84.2 

Holland 91.9  97.8  103.5 

Switzerland 127.4  128.3  125.9 

Austria 68.9  74.7  78.3 

Hungary 30.7  39.1  43.6 

Italy 50.9  55.2  63.6 

France  (cities) 97.3  92.1  102.7 

Combined  average 69.1  74.2  81.0 

This  table  brings  out  the  striking  fact  that  for  all  European  countries, 
with  the  exception  of  Switzerland,  decidedly  higher  cancer  death  rates 
prevailed  during  the  five  years  ending  with  1910  than  during  the  quin- 
quennial period  ending  with  1900.  For  all  of  the  countries  combined 
the  cancer  death  rate  has  increased  from  69.1  per  100,000  of  population 
during  the  first  five  years  to  74.2  during  the  second  and  to  81.0  during 
the  third.  The  cancer  death  rate  of  Switzerland  has  attained  to  so 
extremely  high  a  proportion  that  a  maximum  point  of  frequency  has 
probably  been  reached.*  Of  course,  in  the  case  of  small  communities 
much  higher  death  rates  may  be  and  are  frequently  experienced,  and 
this  is  also  true  for  certain  cities;  but  for  large  countries  as  a  whole  it 
would  probably  be  safe  to  assume  a  maximum  attainable  average  cancer 
mortality  rate  of  not  less  than  130  per  100,000  of  population. 

For  the  principal  European  countries  the  average  cancer  death  rates 
for  recent  years  are  briefly  summarized  below : 

EUROPEf 

rp  .    ,  Deaths  Rate  per 

„    ^'^*^f  from  100,000 

Population  (.^^^pj.  Population 

Austria 141,462,903  113,221  80.0 

Belgium 36,936,410  24,712  66.9 

Channel  Islands  (Guernsey)...  208,900  227  108.7 

Denmark  (cities) 5,453,322  7,747  142.1 

England  and  Wales 178,980,717  174,602  97.6 

France 196,878,000  148,662  75.5 

German  Empire 318,876,524  277,710  87.1 

*The  high  cancer  death  rate  of  Switzerland  is  not  the  result  of  an  excess  in  the  proportion  of  popula- 
tion ages  45  and  over.  According  to  the  most  recent  census  returns,  this  proportion  was  2^2.61  per  cent,  for 
Switzerland,  22.85  per  cent,  for  Denmark,  21.36  per  cent,  for  England  and  Wales,  and  18.89  per  cent,  for  the 
United  Slates. 

fThe  data  used  in  this  table  are,  as  far  as  practicable,  for  the  period  1908-12.  For  information  in  detail 
see  Table  4,  Appendix  G. 

134 


FOREIGN  CANCER  STATISTICS 

EUROPE— Continued 


Deaths  Rate  per 

Total  from  100,000 

Population  Cancer  Population 

Gibraltar* 97,823  81  82.8 

Greece  (cities) 2,117,670  1,100  51.9 

Holland 29,479,395  31,375  106.4 

Hungary 104,006,496  47,374  45.5 

Ireland 21,925,004  17,796  81.2 

Isle  of  Man 261,530  339  129.6 

Italy 171,995,665  112,087  65.2 

Malta 1,056,196  512  48.5 

Norway 11,774,100  11,461  97.4 

Portugal 29,060,580  6,504  22.4 

Roumania  (cities) 6,410,450  3,940  61.5 

Russia(MoscowandPetrograd)  8,624,796  7,812  90.6 

Scotland 23,686,521  24,399  103.0 

Serbia 13,876,836  1,669  12.0 

Spain 97,705,000  51,135  52.3 

Sweden  (cities) 6,685,581  7,022  105.0 

Switzerland 18,686,442  23,228  124.3 

Turkey  (Constantinople) 5,750,000  2,001  34.8 

Total 1,431,996,861  1,096,716  76.6 

Population,  1911 291,384,190 

Limitations  of  European  Cancer  Data 

The  average  cancer  death  rate  for  this  group  of  countries  was  76.6  per 
100,000  of  population.  This  rate  is  based  on  a  mean  population  of  the 
countries  considered  of  nearly  300,000,000.  The  rates  are  not  always 
for  the  countries  as  such,  but  in  some  cases  only  for  political  subdivisions 
or  large  cities.  Precise  information  regarding  the  details  of  this  tabula- 
tion will  be  found  in  the  notes  following  Table  4  of  Appendix  G.  In 
further  explanation  it  requires  to  be  pointed  out  that  the  high  rate  for 
Denmark  is  partly  the  result  of  the  fact  that  the  returns  are  limited  to 
cities  and  towns,  since  the  data  are  not  made  available  for  the  Danish 
Kingdom  as  a  whole.  The  high  rates  for  the  Isle  of  Man  (129.6)  and 
the  Channel  Islands  (108.7)  are  suggestive.f     The  extremely  low  rate 

*The  following  interesting  reference  to  Cancer  in  Gibraltar  is  from  the  Colonial  Office  Correspondence  in 
connection  with  the  Imperial  Cancer  Research  Scheme  (Part  I,  p.  31) :  "The  organs  chiefly  affected  by  cancer  in 
natives  of  Gibraltar,  and  in  Spaniards  residing  in  the  neighborhood,  are,  in  males,  the  lips  and  tongue;  in 
females,  the  uterus  and  breast.  Probably  three-fourths  of  all  cases  of  cancer  met  with  in  the  practice  of  the 
Colonial  Hospital,  have  their  seat  in  one  or  the  other  of  these  organs.  The  predisposing  causes  of  cancer, 
in  this  part  of  the  world,  appear  to  me  to  be,  in  males,  excessive  tobacco  smoking,  leading  to  irritation  of  the 
lips  and  tongue;  in  females,  premature  child-bearing  and  lactation.  The  Spaniard's  cigarette  or  cigar  is  never 
absent  from  his  lips  if  he  can  help  it,  and  he  allows  it  to  burn  so  close  that  the  actual  fire  must  frequently 
char  the  epithelium  of  his  mouth.  Again,  in  females,  the  generative  organs  come  to  maturity  at  a  relatively 
early  period,  as  compared  with  the  general  development  of  the  frame,  and  consequently  early  sexual  relations 
and  child-bearing  are  frequent.  This  results  in  undue  irritation  and  injury  of  the  genital  tract  at  a  stage  when 
its  component  tissues  are  as  yet  immature,  and  a  condition  of  cell  proliferation  is  set  up  which,  at  some  future 
time,  predisposes  to  cancer  formation." 

fThe  proportion  of  population  ages  45  and  over  in  the  Isle  of  Man  and  in  the  Isle  of  Guernsey  are  rather  high, 
but  by  no  means  decidedly  excessive.  For  the  Isle  of  Man,  according  to  the  census  of  1911,  the  proportion 
was  26.9  per  cent.,  and  for  thg  Isle  of  Guernsey  24.2  per  cent.  The  corresponding  proportion  for  England 
and  Wales  was  21.4  per  cent. 

135 


THE  MORTALITY  FROM  CANCER 

for  Serbia  (12.0)  is,  no  doubt,  in  part  at  least,  the  result  of  defective 
death  registration  and  poor  medical  attendance.  There  are,  however, 
in  all  probability  local  conditions  which  make  for  a  low  cancer  death 
rate  in  Serbia,  for  as  shown  by  the  returns  for  Roumania  the  cancer 
death  rate  for  that  country  was  not  much  below  the  average  for  the 
European  continent  as  a  whole. 

Among  the  numerous  special  tables  of  exceptional  interest  are  the 
returns  for  Ireland,  by  duration  of  illness,  for  Norway,  by  geographical 
districts,  for  Bavaria,  by  geographical  divisions,  for  Munich,  by  religious 
confession,  for  France,  by  the  size  of  cities,  ior  Switzerland,  by  cantons, 
according  to  the  predominating  German,  French  or  Italian  population, 
for  ^' ienna,  with  special  reference  to  the  Jewish  population,  for  Hungary, 
by  principal  races,  and  for  Italy,  by  provinces.  All  these  tables  sug- 
gest the  practical  utility  of  specialized  local  statistical  cancer  studies, 
which  are  likely  to  yield  important  results. 

Comparative  Cancer  Mortality  Rates  for  Africa 

The  available  cancer  statistics  for  certain  political  subdivisions  of  the 
Continent  of  Africa  are  given  in  the  table  following: 
AFRICA* _^_ 

rp  .   1  Deaths  Rate  per 

■p  i  ,  t-  from  100,000 

Population  Cancer  Population 

Algeria  (Europeans  only) 3,688,433  1,257  34.1 

Cape  Colony  (cities) 1,898,895  1,067  56.2 

Mauritius 1,843,819  171  9.3 

Natal 1,111,756  366  32.9 

Sierra  Leone  (Freetown) 68,218  9  13.2 

Transvaal  (Johannesburg) 430,745  148  34.4 

Total 9,041,866  3,018  33.4 

Population,  1911 1,959,645 

The  cancer  mortality  returns  for  practically  all  the  African  countries 
are  of  doubtful  intrinsic  value.  Most  of  the  information  is  of  a  frag- 
mentary character,  due,  naturally,  to  the  exceptional  governmental 
conditions  and  the  proportionately  large  native  population.  The  com- 
bined cancer  mortality  rate  for  African  countries  was  only  33.4  per 
100,000  of  population.  The  exceptionally  low  rate  for  Mauritius  (9.3) 
is  partly  explained  by  the  large  East  Indian  population,  and  the  relatively 
much  higher  rate  for  Algeria  (34.1)  is  due  to  the  fact  that  the  rate 
is  for  the  European  population.  There  are  no  cancer  statistics  for 
Egypt  or  even  for  Cairo  and  Alexandria  that  could  be  utilized  in  con- 
nection with  the  present  investigation.!  Among  the  more  interesting 
data  in  relation  to  the  African  continent  are  the  hospital  statistics  for 
Mauritius,  the  returns  for  Johannesburg,  by  race,  the  hospital  statistics 

*The  data  used  in  this  table  are,  as  far  as  practicable,  for  the  period  1908-12.  For  information  in  detail 
see  Table  217,  Appendix  G. 

fThe  occurrence  of  cancer  in  Egypt  has  been  discussed  by  W.  R.  Williams  in  his  "Natural  History  of 
Cancer,"  and  also  in  the  third  volume  of  the  treatise  on  cancer  by  J.  Wolff  (p.  190).  According  to  F.  C.  Madden, 
in  a  treatise  on  the  "Diseases  of  the  Orient,"  cancer  was  ascertained  to  be  extremely  rare  among  the 
Berbers  and  Sudanese,  who  are  vegetarians,  the  cases  observed  being  practically  limited  to  the  Arabs  and  the 
CopJ^,  who  have  more  or  less  adopted  the  European  mode  of  life. 

136 


FOREIGN  CANCER  STATISTICS 

for  Freetown,  which  is  the  capital  of  Sierra  Leone,  and  the  hospital 
returns  for  Portuguese  Guinea.  These  returns  are  merely  indicative 
of  sources  of  information  which  have  thus  far  been  utilized  to  only  a 
limited  extent  in  the  scientific  study  of  the  cancer  problem.  The  data 
collected  for  the  British  Colonies  through  the  Imperial  Cancer  Research 
Fund  have  failed  to  yield  the  abundant  amount  of  material  which  an 
energetic  and  persistent  collective  effort  on  the  part  of  the  respective 
governments  and  the  medical  profession  could  unquestionably  bring 
forth.  The  local  possibilities  of  specialized  cancer  research  find  their 
best  illustration  in  the  discussion  of  the  spread  of  cancer  among  the 
descendants  of  the  liberated  Africans  or  Creoles,  by  W.  Renner,  M.  D., 
appended  to  the  annual  report  of  the  Medical  Department  for  the  Colony 
of  Sierra  Leone,  for  the  year  ending  December  31,  1909.  When  every 
reasonable  allowance  is  made  for  the  want  of  accuracy  and  com- 
pleteness in  the  available  returns  for  the  African  continent,  it  would 
seem  safe  to  assume  that  cancer  is  of  a  relatively  very  low  degree  of  fre- 
quency in  African  countries,  even  among  the  white  population  of  Euro- 
pean origin,  and  that  among  the  native  population,  as  a  general  rule, 
malignant  disease  is  extremely  rare. 

Comparative  Cancer  Mortality  Rates  for  Asia 

The  available  statistics  for  the  Continent  of  Asia  are  briefly  sum- 
marized in  the  next  table: 

ASIA* 

Total 
Population 

Ceylon 20,076,320 

Hongkong 1,737,310 

India  (Calcutta) 4,456,200 

Japan 242,460,425 

Penang 1,391,089 

Philippine  Islands  (Manila) 1,190,154 

Shanghai  (Europeans  only) 68,684 

Singapore 1,434,780 

Total 272,814,962  148,447  54.4 

Population,  1911 57,820,460 

The  average  cancer  death  rate  for  the  Continent  of  Asia,  according  to 
this  table,  is  54.4  per  100,000  of  population,  as  compared  with  a  rate 
of  33.4  for  the  Continent  of  Africa.  The  rate  therefore  approaches  more 
closely  to  the  European  average  of  76.6,  and  particularly  so  in  the  case 
of  Japan,  for  which  country  the  rate  was  60.2.  f  For  certain  subdivisions 
of  the  Continent  of  Asia  the  rates  are  unusually  low,  especially  for 

*The  data  used  in  this  table  are,  as  far  as  practicable,  for  the  period  1908-12.  For  information  in  detail 
see  Table  232,  Appendix  G. 

fSome  exceedingly  interesting  observations  regarding  cancer  in  Japan  have  been  published  in  the  periodical 
Gann,  in  German,  under  the  title  "Results  of  Cancer  Research  in  Japan,"  for  the  year  1907.  Additional 
information  of  a  trustworthy  character  is  contained  in  the  special  analysis  of  the  causes  of  death  among  persons 
insured  with  the  Meiji  Life  Insurance  Company  of  Japan. 

137 


Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1,133 
140 

5.Q 
8.1 

522 

11.7 

145,965 
143 

60.2 
10.3 

325 

27.3 

38 

55.3 

181 

12.6 

THE  MORTALITY  FROM  CANCER 

Ceylon,*  Hongkong,!  Calcutta,  Penang  and  Singapore.  For  Shanghai, 
hoTvever,  the  rate  for  the  European  population  is  as  high  as  55.3,  which 
closely  approaches  to  the  average  cancer  death  rate  of  European  coun- 
tries of  about  fifteen  years  ago.  That  this  rate  for  Shanghai  is  quite 
trustworthy  is  brought  out  by  the  fact  that  the  corresponding  death  rate 
of  Europeans  in  Manila  is  50.6.  Among  the  most  interesting  returns  for 
the  several  countries  of  Asia  are  those  of  the  city  of  Calcutta,! 
which  extend  over  nearly  forty  years,  the  hospital  data,  by  organs  and 
parts,  for  Singapore,  the  special  statistics  for  the  European  population 
of  the  Dutch  East  Indies,  the  returns  for  the  foreign-resident  population 
of  Shanghai,  the  returns,  by  organs  and  parts,  for  Japan  §  and  the  cor- 
responding information  for  the  city  of  Manila. 

Comparative  Cancer  Rates  for  Australasia 

For  Australasia  the  cancer  statistics,  on  account  of  the  relatively 
much  larger  European  population,  are  naturally  of  a  more  satisfactory 
character.  The  indigenous  population  in  most  of  the  countries  considered 
is  relatively  a  negligible  factor.  The  general  results  are  summarized 
in  the  following  table : 

AUSTRALASIA  || 

Deaths  Rate  per 

Total  from  100,000 

Population  Cancer  Population 

Hawaii 962,860  392  40.7 

New  South  Wales 8,142,200  5,948  73.1 

New  Zealand 4,963,912  3,731  75.2 

Northern  Territory 6,678  3  44.9 

Queensland 2,961,089  1,870  63.2 

South  Australia 1,996,995  1,525  76.4 

Tasmania ; 950,717  621  65.3 

Victoria 6,521,936  5,441  83.4 

Western  Austraha 1,380,353  814  59.0 

Total 27,886,740  20,345  73.0 

Population,  1911 5,703,425 

*Malignant  disease,  according  to  the  Colonial  Office  Correspondence  in  the  furtherance  of  the  Imperial 
Cancer  Research  Scheme  (Part  I,  p.  63)  is  comparatively  rare  in  Ceylon,  the  average  age  at  death  being  about 
forty  years.  The  principalform  of  the  disease  is  cancer  of  the  buccal  cavity,  which  is  attributed  to  the  chewing 
of  betel.  This  is  described  as  consisting  of  " tobacco, betelleaves,areca  nut,  and  alittle  slakedlime  to  promote  the 
flow  of  the  saliva."  It  is  stated  that  every  native  chews  betel  and  eats  curry  flavored  with  hot  chilies,  so  that 
there  are  invariably  two  irritants  present  in  the  mouth,  either  of  which  may  determine  the  occurrence  of  malig- 
nant new  growth.     Cancer  of  the  breast  is  rare,  though  native  women  suckle  their  children  a  long  time. 

fAccording  to  the  Colonial  Office  Correspondence  in  the  furtherance  of  the  Imperial  Cancer  Research 
Scheme  (Part  II,  p.  16),  the  post-mortem  records  of  Hongkong  show  that  out  of  15,365  Chinese,  only  ten  were 
found  to  have  died  of  malignant  disease.  The  following  extract  is  also  from  the  Correspondence  of  the  Colonial 
Office  in  connection  with  the  Imperial  Cancer  Research  Scheme  (Part  II,  p.  17).  Cancer  among  Chinese 
in  Hongkong.  "In  the  case  of  a  disease  in  which  the  mean  annual  death-rate  is  only  4.45  per  100,000, 
personal  idiosjTicrasies  are  of  more  moment  than  the  habits  of  the  community,  but  of  these  former  I  have  no 
information.  As,  however,  the  habits  of  the  community  may  throw  some  light  on  the  fact  that  the  Chinese  in 
Hongkong  enjoy  a  marked  immunity  from  maligoant  disease,  I  may  say  that  they  smoke  but  little  in  com- 
parison with  the  European,  they  practically  do  not  chew  at  all,  and  their  diet  consists  in  the  main  of  rice, 
with  small  quantities  of  fish  or  pork,  and  that  spices,  peppers  and  hot  chilies  are  not  used  by  them  to  any 
appreciable  extent.  The  Chinese  'soy,'  or  sauce,  of  which  very  little  is  used  at  a  time,  is  a  verj'  mild  aromatic 
liquid,  ha\-ing  a  slightly  vinegary  taste.  In  the  case  of  the  Chinese  in  Hongkong  it  is  principally  the  alimen- 
tary canal  and  the  abdominal  viscera  that  are  affected." 

tOf  special  interest  in  this  connection  are  the  researches  of  Rogers  of  Calcutta,  including  a  study  of  one 

138 


FOREIGN  CANCER  STATISTICS 

The  average  cancer  death  rate  for  Australasia  was  73.0,  which  ap- 
proaches quite  near  to  the  average  European  rate  of  76.6.  The  rate  was 
highest  in  the  State  of  Victoria,  83.4,  and  lowest  in  Hawaii,  40.7.  The 
cancer  death  rate  of  Hawaii,  which  for  present  purposes  has  been  in- 
cluded within  the  geographical  limits  of  Australasia,  is  naturally  affected 
by  the  preponderating  Asiatic  elements.  Among  the  interesting  tables 
for  Australasia  is  a  summary  return  for  the  Commonwealth  of  Australia 
by  organs  and  parts,  with  distinction  of  sex,  as  given  in  an  abbreviated 
form  below: 

Mortality  from  Cancer  in  the  Commonwealth  of  Australia,  by  Organs 

and  Parts,  according  to  Sex,  1908-1912 

Rate  per  100,000  of  Population 

MALES  FEMALES 

Buccal  cavity 11.5  1.2 

Stomach  and  liver 31.8  22.6 

Peritoneum,  intestines,  rectum 8.2  9.0 

Breast 10.6 

Female  generative  organs 15.5 

Skin 3.0  1.5 

Other  organs 19,2  12.2 

Total 73.8 72^6 

The  rates  for  Australia  may  be  considered  as  comparable  with  the 
corresponding  cancer  statistics  for  the  United  States  and  Europe.  For 
Fiji  the  hospital  statistics  have  been  included,  on  account  of  the  special 
interest  which  attaches  to  the  returns  of  cancer  occurrence,  by  organs 
and  parts,  according  to  race.  It  is  regrettable  that  there  should  not 
be  more  conclusive  information  available  in  detail  for  Hawaii. 

Comparative  Cancer  Mortality  Rates  for  the  Western  Hemisphere 

For  the  American  Continent  and  other  parts  of  the  Western  Hemis- 
phere the  returns  have  been  summarized  in  the  table  following,  which 
represents  a  registration  area  with  approximately  83,000,000  population. 
For  most  of  the  countries  considered  the  returns  are  limited  to  the  large 
cities,  and  complete  returns  are  not  even  available  for  the  entire  United 
States.  The  average  rate  for  the  Western  Hemisphere,  as  determined 
by  this  tabulation  is  65.7,  but  the  range  in  the  rate  is  quite  considerable, 
and  some  exceptionally  high  rates  reported  for  certain  localities  require 
further  consideration  to  establish  their  accuracy.  In  the  summary 
table  the  average  rate  for  the  registration  area  of  the  United  States 
has  been  included,  to  facilitate  convenient  comparison;  but  the  statis- 
tical details  for  this  section  are  given  separately  in  Appendix  F,  Part  1, 
following  the  more  extended  discussion  of  the  cancer  mortality  of  this 
country. 

thousand  autopsy  records,  the  results  of  which  were  made  public  in  the  India  Medical  Gazette.  The  evidence 
tends  to  show  that  cancer  was  comparatively  rare  among  the  natives  of  India. 

^According  to  K.  Sato,  as  quoted  by  Coley,  of  64,030  patients  treated  in  Japanese  hospitals,  only  2.14  per 
cent,  suffered  from  cancer.  The  proportions  in  which  the  various  organs  were  affected  were  uterus,  33.5 
per  cent.,  stomach,  32.0  per  cent.,  intestines,  6.2  per  cent.,  breast,  6.7  per  cent.,  skin,  2.0  per  cent.,  oesophagus, 
1.5  per  cent. 

IIThe  data  used  in  this  table  are,  as  far  as  practicable,  for  the  period  1908-12.  For  information  in  detail 
see  Table  259,  Appendix  G. 

139 


THE  MORTALITY  FROM  CANCER 

AMERICA* 
Western  Hemisphere 


Deaths  Rate  per 

Total  from  100,000 

Population  Cancer  Population 

Argentina* 17,807,056  11,392  64.0 

Bermuda 92,780  52  56.0 

Bolivia  (La  Paz) 316,090  69  21.8 

Brazil  (cities) 9,384,279  3,145  33.5 

British  Guiana 1,487,922  271  18.2 

British  Honduras 197,820  29  14.7 

British  West  Indies* 6,897,104  1,439  20.9 

Canada* 19,689,825  12,208  62.0 

Chile 17,047,786  6,077  35.6 

Colombia  (Bogota) 242,986  218  89.7 

Costa  Rica 1,849,534  751  40.6 

Cuba 10,892,077  4,855  44.6 

Danish  W.Ind.  (Is.  of  St.Thomas)  53,393  63  118.0 

Dutch  Guiana  (Paramaribo) ....  174,775  167  95.6 

Ecuador  (Guayaquil) 200,000  122  61.0 

Mexico  (City  of  Mexico) 2,355,330  1,165  49.5 

Newfoundland 1,192,843  616  51.6 

Nicaragua 2,180,000  231  10.6 

Peru  (Lima) 170,000  202  118.8 

Salvador  (San  Salvador) 357,240  208  58.2 

United  States  (Reg.  Area) 271,207,437  202,621  74.7 

Uruguay 5,421,854  3,577  66.0 

Venezuela 13,331,180  1,960  14.7 

Total 382,549,311  251,438  65.7 

Population,  1911 82,835,662 

For  most  of  the  islands  of  the  West  Indies  the  rates  are  exceptionally 
low,  a  condition  readily  explained  by  the  preponderating  negro  popu- 
lation. The  relatively  high  rates  for  Bermuda  (56.0)  and  the  Danish 
West  Indies  (118.0)  are,  no  doubt,  explained  by  the  high  proportion 
of  white  population  and  special  hospital  facilities  made  use  of  by  others 
than  residents  of  the  immediate  locality.  The  low  rate  for  Venezuela 
is  probably,  in  part  at  least,  the  result  of  defective  registration  and  poor 
medical  facilities  in  the  interior.  The  relatively  low  rate  for  Trinidad 
is  partly  explained  by  the  high  proportion  of  East  Indians  in  the 
Trinidad  population.  There  is  at  present  no  explanation  for  the  rather 
excessive  rates  of  cancer  frequency  returned  for  the  large  cities  of  the 
United  States  of  Colombiaf  and  Peru.  The  rates  for  these  countries, 
being  limited  to  the  capital  cities,  are  probably  increased  by  hospital 
accommodation  for  operative  treatment. 

*The  data  used  in  this  table  are,  as  far  as  practicable,  for  the  period  1908-12.  For  information  in  detail 
see  Table  29(),  Appendix  G. 

fA  curious  error  occurs  in  the  statistical  survey  of  cancer  throughout  the  world  in  the  third  volume  of 
J.  Wolff's  treatise  on  cancer,  iu  which  the  District  of  Columbia  of  the  United  States  is  confused  with  the 
United  States  of  Colombia,  and  given  accordingly  in  the  discussion  of  cancer  in  South  America.  (Lehre 
von  dcr  Krebskrankheit,  Vol.  iii,  p.  25.) 

140 


FOREIGN  CANCER  STATISTICS 

Among  the  more  interesting  tables  for  the  Western  Hemisphere  are  the 
cancer  statistics  for  Cuba,  by  organs  and  parts,  according  to  sex  and 
race,  the  statistics  for  the  city  of  Mexico,  by  organs  and  parts;  and  the 
corresponding  returns  for  the  city  of  San  Salvador,  limited  to  a  single 
year,  the  returns  for  the  city  of  Lima,  Peru,  by  organs  and  parts,  with 
distinction  of  sex,  but  with  rates  calculated  only  for  both  sexes  combined, 
on  account  of  the  want  of  trustworthy  data  regarding  the  sex  distribution 
of  the  population.  The  high  rate  for  the  city  of  Trujillo,  Peru,  is  of 
doubtful  accuracy  and  possibly  impaired  by  the  indefinite  information 
regarding  the  exact  population  returns.  Two  tables  have  been  in- 
cluded for  the  federal  district  of  Rio  de  Janeiro,  showing  the  percentage 
distribution  of  cancer  deaths,  by  organs  and  parts  and  according  to  sex, 
and  there  is  a  similar  table  for  the  city  of  Bahia,  Brazil,  and  the  city  of 
Buenos  Aires,  Argentina.  For  the  city  of  Santiago,  Chile,  a  table  is  in- 
cluded of  the  mortality  from  cancer,  by  organs  and  parts,  but  without 
reference  to  sex.  There  is  a  similar  table  for  the  Republic  of  Uruguay, 
and  separately  for  the  city  of  Montevideo. 

Inherent  Limitations  of  International  Cancer  Data 

For  many  of  the  countries  considered  the  returns  are  unquestionably 
of  doubtful  value,  and  strong  reasons  exist  why,  perhaps,  some  of  the 
returns  should  have  been  excluded  on  account  of  their  apparent  intrinsic 
untrustworthiness.  Since,  however,  the  primary  purpose  of  this  work 
is  to  encourage  research  into  the  statistical  intricacies  of  the  can- 
cer problem,  it  has  seemed  advisable  to  include  such  data,  obtained 
with  great  difficulty,  as  a  result  of  extended  correspondence  with  re- 
mote countries,  as  evidence  of  the  effort  to  make  the  present  study 
as  useful  as  possible  for  future  research.  The  acceptance  or  the  rejec- 
tion of  any  particular  group  of  facts  must,  after  all,  remain  a  matter 
of  individual  concern,  in  view  of  the  magnitude  of  the  undertaking 
and  the  truly  enormous  complexity  of  the  problem  of  accuracy  and  com- 
pleteness. In  the  case  of  many  of  the  returns  for  countries  and  localities 
throughout  the  entire  world,  with  widely  varying  conditions  of  govern- 
mental supervision  and  control,  it  would  seem  a  doubtful  procedure 
to  reject  or  exclude  data  which,  after  all,  may  be  worthy  of  serious 
consideration  and  therefore  useful  for  the  end  in  view. 

Cancer  a  World-wide  Menace 
A  summary  review  of  the -available  cancer  mortality  statistics  for  the 
civilized  world  involves  unusual  difficulties,  on  account  of  the  widely 
varying  degree  of  the  inherent  trustworthiness  of  the  returns  for  the 
different  countries  considered.  That  the  menace  of  cancer  is  world- 
wide is  a  far-reaching  conclusion  which  can  not  be  successfully  contra- 
dicted by  conspicuous  illustrations  of  occasional  statistical  fallacies  or 
by  exceptional  instances  of  inaccuracies  in  the  mortality  returns. 
In  the  main,  the  statistics  for  civilized  countries  are  an  approximately 
trustworthy  indication  of  the  tendency  of  the  cancer  death  rate  to 
approach  a  maximum  of  perhaps  130  per  100,000  of  population. 
This  maximum  is  far  from  having  been  reached  in  the  case  of  a 
large  number  of  countries  and  representative  communities,  in  which, 
however,  the  rate  is  persistently  on  the  increase  from  year  to  year.     It 

141 


THE  MORTALITY  FROM  CANCER 

has  properly  been  observed  that  "no  statistical  judgment  deals  with  the 
unit  but  strictly  and  only  with  the  aggregate."  In  the  case  of  the 
present  investigation  a  truly  immense  amount  of  statistical  information 
regarding  a  single  disease  or  a  strictly  limited  group  of  kindred  diseases 
has  been  brought  together,  not  for  the  primary  purpose  of  establishing 
the  causes  or  conditioning  circumstances  of  the  cancer  problem,  but  with 
the  object  in  view  of  making  the  existing  statistical  data  conveniently 
available  for  further  study  and  analysis  to  students  of  the  cancer  prob- 
lem throughout  the  world.  The  quality  of  the  data  is  of  course  not 
improved  by  the  mere  quantity  of  the  facts  collected,  but  certain  in- 
equalities and  errors  due  to  small  numbers  are  eliminated,  with  the 
result  that  the  general  principles  deducible  from  the  facts  are  more 
precisely  established. 

Cancer  Frequency  according  to  Latitude 

The  foregoing  principles  of  statistical  inquiry  may  properly  be 
applied  to  the  interesting  question  as  to  whether  there  is  a  clearly 
established  relationship  between  cancer  frequency  and  latitude.  In 
the  following  table  the  facts  have  been  brought  together  in  a  readily 
comprehended  form,  on  the  basis  of  a  city  population  for  1912  of 
69,520,000  and  a  total  number  of  cancer  deaths  during  the  five  years 
ending  with  1912  of  nearly  300,000.  The  latitude  is  given  by  groups  in 
a  convenient  form,  but  unfortunately  most  of  the  large  cities  considered 
are  north  of  latitude  30  degrees,  and  the  aggregate  population  for  cities 
south  of  that  latitude  is  relatively  small,  compared  with  the  number 
of  inhabitants  of  cities  in  northern  latitudes.  Subject  to  this  limitation, 
however,  the  table  makes  an  interesting  contribution  to  the  geographical 
study  of  the  cancer  problem. 

Mortality  from  Cancer  in  Cities  according  to  Latitude 
1908-1912 


Rate  per 

No.  of 

Deg 

Tees  of 

Population 

Total 

Deaths  from 

100,000 

Cities 

Latitude 

1912 

Population 

Cancer 

Population 

35 

60  N. 

-50  N. 

23,980,086 

112,912,675 

119,374 

105.7 

48 

50  N. 

-40  N. 

27,519,705 

131,256,257 

121,216 

92.4 

24 

40  N. 

-30  N. 

10,195,197 

47,944,253 

37,451 

78.1 

7 

30  N. 

-ION. 

2,780,447 

13,476,168 

5,696 

42.3 

4 

ION. 

-10  S. 

559,630 

2,583,495 

1,056 

40.9 

7 

10  S. 

-30  S. 

1,806,951 

8,066,144 

3,040 

37.7 

5 

30  S. 

-40  S. 

2,678,287 

12,297,218 

11,048 

89.8 

130 

69,520,303 

328,536,210 

298,881 

91.0 

It  is  shown  by  this  table  that  the  average  cancer  death  rate  for  130  of 
the  world's  large  cities  during  the  period  ending  with  1912  was  91.0 
per  100,000  of  population.  The  rate  was  highest  in  the  most  northern 
inhabited  latitude,  or  that  section  of  the  globe  which  is  comprehended 
within  50  and  60  degrees  north  latitude.*  The  rate  for  this  section 
was   105.7,  diminishing  to  92.4  for  cities  located  within    40  and  50 

*Thc  arctic  and  antarctic  regions  are  for  the  present  purposes  considered  as  uninhabited  portions  of 
the  globe.  The  cancer  death  rate  of  Hammerfest,  Norway,  th;  northernmost  city  of  the  world  (latitude 
70°  40'  N.),  during  1906-10  was  132.0  per  100,000  of  population,  and  139.8  during  1911. 

142 


FOREIGN  CANCER  STATISTICS 


degrees  to  78.1  for  cities  between  30  and  40  degrees,  to  42.3  for  cities 
between  10  and  30  degrees,  to  40.9  for  cities  between  10  degrees  north 
latitude  and  10  degrees  south  latitude,  and,  finally,  to  37.7  for  cities 
between  10  and  30  degrees  south  latitude.  In  the  most  southerly 
inhabited  belt,  between  30  and  40  degrees  south  latitude,  the  cancer 
death  rate  again  rises  to  89.8,  which  is  practically  equivalent  to  the 
rate  for  30  to  50  degrees  north  latitude.  The  table,  therefore,  would 
seem  to  warrant  the  important  conclusion  that  cancer  frequency  is  to 
a  limited  extent  determined  by  latitude,  which,  of  course,  more  or  less 
determines  the  climate  and  weather  conditions ;  in  other  words,  cancer 
is  excessively  common  in  the  temperate  zone,  moderately  common  in 
the  medium  zone  and  relatively  rare  in  the  torrid  or  semi-torrid  zone, 
which  for  the  present  purpose  may  be  construed  to  include  the  belt 
between  latitude  30  north  and  latitude  30  south.* 

Cancer  Frequency  and  Longitude 

On  account  of  the  very  irregular  distribution  of  the  world's  large 
cities  a  geographical  distribution  according  to  latitude  and  longitu/de  is  of 
extremely  doubtful  intrinsic  value.  Other  factors  which  determine  the 
cancer  death  rate  are  frequently  of  sufficient  local  importance  to  seri- 
ously disturb  the  resulting  averages  derived  in  particular  cases  from  a 
relatively  small  number  of  points  of  observation.  In  the  table  following 
the  cancer  data  for  130  cities  are  given  separately  for  the  eastern  and 
western  hemisphere,  according  to  latitude,  but  the  data  are  not  intended 
to  be  considered  as  entirely  conclusive. 


Mortality  from  Cancer  in  Cities,  according  to  Latitude 
Eastern  and  Western  Hemispheres,  1908-1912 

EASTERN  HEMISPHERE 

WESTERN  HEMISPHERE 

Degree  of 
Latitude 

No.  of 
Cities 

Rate  per 

100,000 

Population 

Index 

Number 

No.  of 
Cities 

Rate  per 

100,000 

Population 

Index 
Number 

60N.-50N. 

35 

105.7 

98 

50N.-40N. 

22 

108.4 

100 

26 

77.3 

100 

40N.-30N. 

6 

66.9 

62 

18 

85.5 

111 

30  N.  -10  N. 

3 

13.6 

13 

4 

77.2 

100 

ION. -10  S. 

1 

11.6 

11 

3 

82.7 

107 

10  S.-30  S. 

1 

34.4 

32 

6 

38.2 

49 

30  S.-40  S. 

1 

90.1 

83 

4 

89.8 

116 

Total 

69 

98.3 

61 

78.0 

The  Index  Numbers  for  the  Eastern  and  Western  Hemispheres  do 
not  indicate  a  high  degree  of  correlation,  largely  because  of  the  fact  that 

*The   following   data   (original   calculations,   based   on    official    statistics)   are  included   for   convenient 
reference,  regarding  the  normal  climatic  conditions  prevailing  in  the  130  cities,  arranged  according  to  latitude: 


No.  of 

Degree  of 

Mean  Annual 

Mean  A 

Cities 

Latitude 

Temperature 

Rain 

35 

60  N. -50  N. 

48.0° 

29.1 

48 

50  N.  -40  N. 

50.3° 

34.0 

ii 

40  N. -30  N. 

58.5° 

37.9 

7 

30  N.-IO  N. 

72.5° 

57.1 

4 

ION. -10    S. 

74.6° 

83.3 

7 

10  S.-30   S. 

65.9° 

40.3 

5 

30   S. -40    S. 

62,7° 

36.7 

143 


THE  MORTALITY  FROM  CANCER 

the  data  for  tropical  countries  are  rather  insufficient,  and  that  such 
cities  as  Calcutta,  Hongkong  and  Singapore  are  not  strictly  comparable 
with  cities  like  New  Orleans,  Havana  and  Paramaribo,  etc.  Moreover, 
60  to  40  degrees  north  latitude  in  Europe  rather  correspond  with  50  to 
40  degrees  north  in  the  Western  Hemisphere,  as  regards  climatic  con- 
ditions, but  the  exact  climatological  data  have  not  been  available  in 
connection  with  the  present  study  to  determine  the  precise  correlation 
of  temperature,  rainfall,  humidity,  etc.,  to  cancer  frequency.* 

Cancer  Frequency  according  to  Size  of  Cities  , 

It  is  frequently  assumed  that  the  cancer  death  rate  of  large  cities  is 
excessive  chiefly  because  of  the  exceptional  opportunities  for  cancer 
treatment,  including  facilities  for  surgical  operations.  It  is  held  that 
on  this  account  cancer  patients  from  the  surrounding  country  go  to  the 
cities  for  treatment,  often  in  a  far-advanced  stage  of  the  disease,  with 
fatal  results.  Such  deaths,  under  existing  unsatisfactory  methods  of 
registration  are  not,  as  a  rule,  redistributed  according  to  the  residence  of 
the  deceased,  but  are  included  in  the  mortality  of  the  city  where  the 
death  occurred.  To  a  limited  extent  this  conclusion  is,  no  doubt,  in  con- 
formity with  the  facts,  but  its  importance  is  likely  to  be  overrated.  In 
the  table  following,  the  cancer  death  rates  of  130  of  the  world's  principal 
cities  have  been  brought  together  in  three  groups,  according  to  size,  as  to 
whether  the  population  was  1,000,000  and  over  or  between  250,000  and 
1,000,000  or  less  than  250,000. 

Mortality  from  Cancer  in  Cities,  according  to  Size 
1908-1912 

Deaths  Rate  per 

No.  of  Population  Aggregate  from  100,000 

Cities  Size  1912  Population  Cancer         Population 

14  1,000,000  and  over  30,872,254  147,889,255  137,531  93.0 
67  250,000-1,000,000  31,907,716  148,806,139  133,286  89.6 
49     Less  than  250,000  6,740,333       31,840,816       28,064       88.1 


130  69,520,303     328,536,210     298,881       91.0 

This  table,  based  upon  an  unusually  large  number  of  observations  and 
nearly  300,000  cancer  deaths,  is  of  exceptional  interest.  The  table 
shows  that  the  very  large  cities  had  the  highest  death  rate  from  cancer,  or, 
specifically,  93.0  per  100,000  of  population;  but  this  rate  was  not  much 
in  excess  of  the  cities  in  the  next  group,  for  which  the  rate  was  89.6; 
and  the  rate  in  the  group  following,  consisting  of  relatively  small  cities, 
was  88.1,  or  nearly  the  same.  The  table  would  seem  to  sustain  the  con- 
clusion that  the  effect  of  the  size  of  cities  on  the  cancer  death  rate  is  not 
of  material  importance.  To  facilitate  the  convenient  study  of  the 
general  results  of  this  inquiry  into  the  geographical  aspects  of  the  cancer 
problem,  the  data  have  been  consolidated  in  the  form  of  a  series  of 
tables  for  large  cities,  with  all  the  essential  facts  of  latitude,  population, 

*For  much  valuable  statistical  information  on  climate  and  mortality,  with  some  reference  to  cancerf  see 
"Mortality  of  the  Western  Hemisphere,"  Panama-Pacific  Memorial  Publication  No.  3,  issued  in  connection 
with  an  exhibit  on  Life  Insurance  Methods  and  Results  at  the  Panama-Pacific  International  Exposition. 
San  Francisco,  1915,  by  The  Prudential  Insurance  Company  of  America. 

144 


FOREIGN  CANCER  STATISTICS 

number  of  cancer  deaths  and  rates  per  100,000  of  population.  The 
details  are  given  in  full  in  Table  3  of  Appendix  E.  As  far  as  possible, 
all  of  the  rates  used  are  for  the  period  1908-12. 

Comparative  Cancer  Death  Rates  of  American  and  European  Cities 

In  concluding  these  observations  on  the  geographical  incidence  of 
cancer,  it  has  seemed  advisable  to  bring  together  the  comparative  can- 
cer death  rates  of  twenty  large  American  cities  and  ten  large  European 
cities,  for  the  period  1881-1912. 

Mortality  from  Cancer,  1881-1912 
Twenty  American  and  Ten  European  Cities  Compared 


Cancer  Death  Rate 
per  100,000 
Period  Population 

1881-1885 48.6 

1886-1890 50.7 

1891-1895 55.0 

1896-1900 60.7 

1901-1905 69.5 

1906-1910 79.3 

1911 83.4 

1912 85.4 


CITIES 

EUROPEAN  CITIES 

Index 

Number 

Cancer  Death  Rate 
per  100,000 
Population 

Index 

Number 

Difference 
in  Rates 

100 

75.4 

100 

26.8 

104 

82.0 

109 

31.3 

113 

87.9 

117 

32.9 

125 

97.2 

129 

36.5 

143 

106.2 

141 

36.7 

163 

114.4 

152 

35.1 

172 

114.7 

152 

31.3 

176 

118.3 

157 

32.9 

According  to  this  table,  the  cancer  death  rate  of  American  cities  during 
the  thirty-two  years  under  observation  has  increased  76  per  cent., 
whereas  for  European  cities  the  increase  was  only  57  per  cent.  The 
actual  increase,  however,  in  the  rate  for  American  cities  was  36.8  per 
100,000  of  population,  against  an  increase  of  42.9  for  European  cities. 
The  actual  increase  in  the  rate  is  unquestionably  of  greater  significance 
than  the  relative  increase,  which  depends  upon  the  attained  degree 
of  cancer  frequency  at  the  beginning  of  the  period  under  considera- 
tion. The  average  cancer  death  rate  for  1912  was  85.4  for  American 
cities,  against  118.3  for  European  cities.  The  evidence  of  an  actual  and 
relative  increase  in  cancer  frequency  in  American  and  European  cities  is 
clearly  established  by  this  analysis,  which  includes  perhaps  the  largest 
amount  of  statistical  material  regarding  a  single  disease  ever  taken  into 
account  in  an  investigation  of  this  kind.  If  the  conclusions  resting  upon 
the  results  of  this  inquiry  are  not  trustworthy,  then  there  is  no  alterna- 
tive but  to  admit  that  the  statistical  method  has  no  place  in  medicine 
and  that  the  law  of  large  numbers  is  fallacious  in  a  case  where  it  would 
seem  that  it  should  be  most  applicable  to  the  facts  considered. 


145 


CHAPTER  IX 

SOME  GENERAL  OBSERVATIONS  AND  CONCLUSIONS  ON  THE 
CANCER  PROBLEM 

Cancer  among  Primitive  Races — Cancer  among  the  Jews — ^North  American  Indians — 
Gypsies — Determinable  Factors  of  Cancer  Frequency — Age  and  Senility — Physical 
Condition — Growth  and  Development — Precancerous  Lesions — Gastric  Ulcers  and 
Gall-stones — Uterine  Cancer — Early  Diagnosis — Hospital  Statistics — Public  Institu- 
tions— Soldiers'  Homes — Surgical  Aspects — Problem  of  Recurrence — Duration  of 
Disease — Degree  of  Malignancy — Clinical  Signs — Anaemia — Prognosis — Heredity — 
Overnutrition — Metabolic  Disorders — Vegetarianism — Diet — Civilization — Theory 
of  Atra  Bills — Biochemical  Aspects — Goitre — Thyroid  Carcinoma — Obesity — 
Alcohol — Smoking — Gall-stones  and  Chronic  Irritation — Tuberculosis — Syphilis 
— Rheumatism — Gout — Diabetes — Appendicitis — Parasitic  Theory — Cancer  Houses 
and  Villages — Cancer  a  Deux  or  Marital  Infection  —  Surgical  Infection — Worry — 
Insanity — Need  of  Educational  Campaign  in  Methods  of  Control — Restatement  of 
Conclusions  and  Results. 

An  extended  statistical  consideration  of  the  cancer  problem  permits  of 
no  other  conclusion  than  that  the  relative  frequency  of  cancer  is  decid- 
edly greater  at  the  present  time  than  in  former  years ;  that  the  disease 
results  in  an  annual  loss  in  the  principal  civilized  countries  of  the  world  of 
not  less  than  500,000  lives,  and  in  the  United  States  (1915)  of  approxi- 
mately 80,000  lives,  and  that  in  this  country  the  cancer  death  rate  is  in- 
creasing at  the  rate  of  about  2.5  per  cent,  per  annum.  In  contrast  to  a 
decreasing  mortality  from  preventable  causes  of  death,  the  mortality 
from  cancer  stands  foremost  as  one  of  the  few  diseases  that  are  on  the 
increase  in  the  countries  for  which  the  official  records  provide  a  sufficiently 
trustworthy  basis  of  conclusive  information.  In  all  probability  the  actual 
frequency  of  cancer  is  somewhat  greater  than  the  indicated  degree  of 
occurrence  as  measured  by  the  annual  death  rate,  since  a  fair  proportion 
of  persons  suffering  from  cancer  die  from  other  causes,  as  best  illustrated 
by  the  occasional  instances  of  the  suicide  of  cancer  patients  unable  to 
longer  endure  what  has  been  fitly  described  as  "the  agony  of  a  living 
death."  It  is  also  a  well-known  fact  that  many  surgical  operations 
are  successful  in  prolonging  the  life  of  cancer  patients,  who  subsequently 
die  from  other  causes.  The  implied  menace  of  cancer  is,  therefore,  more 
serious  than  the  ascertainable  frequency  of  the  disease  by  means  of 
mortality  statistics,  but  these  in  the  main  may  be  said  to  reflect  with  the 
required  degree  of  approximate  accuracy  the  true  liability  of  civilized 
mankind  to  cancer  and  allied  forms  of  malignant  disease*;  It  is,  therefore, 
not  an  exaggeration  to  speak  of  cancer  as  a  menace  and  to  emphasize  its 
importance  as  one  of  the  principal  causes  of  death  to  which  more  at- 
tention should  properly  be  directed,  both  as  a  medical  and  as  a  public 
question,  than  has  heretofore  been  the  case. 

Cancer  among  Primitive  Races 

The  rarity  of  cancer  among  native  races  suggests  that  the  disease  is 
primarily  induced  or  at  least  increased  in  relative  frequency  by  the  con- 
ditions or  methods  of  living  which  typify  our  modern   civilization. 

146 


OBSERl^iTIONS  AND  CONCLUSIONS 

Tiicie  are  no  known  reasons  why  cancer  should  not  occasionally  occur 
among  any  race  or  people,  even  though  it  be  of  the  lowest  degree  of 
savagery  or  barbarism.  Grant  ing  the  practical  difficulties  of  determining 
with  accuracy  the  causes  of  death  among  non-civilized  races,  it  is  ne^•er- 
theless  a  safe  assumption  that  the  large  number  of  medical  missionaries 
and  other  trained  medical  observers,  living  for  years  among  native  races 
throughout  the  world,  would  long  ago  have  provided  a  more  substantial 
basis  of  fact  regarding  the  frequency  of  occurrence  of  malignant  disease 
among  the  so-called  "uncivilized"  races,  if  cancer  were  met  with  among 
them  to  anything  like  the  degree  common  to  practically  all  civilized 
countries.  Quite  to  the  contrary,  the  negative  evidence  is  convincing  that 
in  the  opinion  of  qualified  medical  observers  cancer  is  exceptionally  rare 
among  primitive  peoples,  including  the  North  American  Indians  and  the 
Esquimo  population  of  Labrador  and  Alaska.  Evidence  is  also  available 
to  substantiate  the  conclusion  that  cancer  was  relatively  of  rare  occur- 
rence among  our  negro  population  during  a  condition  of  slavery,  but  that 
the  frequency  rate  has  rapidly  increased  during  the  last  thirty  years,  until 
at  the  present  time  cancer  of  the  uterus  is  proportionately  more  common 
among  negro  women  than  among  the  white  women  living  under  much 
the  same  conditions  of  life  in  the  same  localities. 

Cancer  being  an  affection  more  or  less  liable  to  attack  any  part  of  the 
human  body,  the  variations  in  relative  frequency  in  this  respect  are  of 
especial  etiological  significance.  If  the  causative  or  contributory  factor 
of  cancer  of  the  cheek  in  Ceylon  is  the  habit  of  chewing  the  betel  nut, 
common  to  native  women,  it  is  self-evident  that  the  disease  in  this  form 
would  not  be  likely  to  occur  among  European  women  not  addicted  to 
that  custom.  Even  more  convincing  is  the  evidence  regarding  specific 
causative  or  contributory  factors  in  cancer  occurrence  met  with  in  the 
case  of  the  natives  of  Afghanistan,  who  are  peculiarly  liable  to  the  so- 
called  Kangri  cancer,  or  malignant  disease  of  the  external  abdomen, 
caused  by  burns  produced  incidental  to  the  wearing  of  a  charcoal-stove, 
on  account  of  the  low  temperature  common  to  excessive  altitudes.  No 
such  cancers  are  met  with  in  civilized  countries,  where  certainly  the 
diagnosis  would  be  made  without  difficulty,  since  these  cancers  are  of  the 
external  variety.  Similar  conclusions  apply  to  chimney-sweeps'  cancer 
in  England,  and  Roentgen-ray  carcinoma,  limited  to  X-ray  workers. 
For  the  same  reason,  cancer  of  the  breast,  the  uterus,  or  the  stomach  may 
reasonably  be  supposed  to  be  rare  among  one  class  of  people  and  com- 
mon among  another,  without  regard  to  accuracy  of  diagnosis  or  complete- 
ness of  death  certification :  in  other  words,  the  variations  in  cancer  death 
rates  may  be  priitiarily  explained  by  decided  though  possibly  not 
easily  ascertainable  differences  in  local  conditions,  habits,  customs,  mode 
of  life,  etc.,  and,  to  a  much  lesser  degree,  to  possible  inaccuracies  or 
deficiencies  in  diagnosis,  etc. 

Cancer  among  the  Jews 

The  statistical  data  concerning  the  comparative  cancer  frequency 
among  the  Jews  are  rather  conflicting.  More  or  less  contradictory 
conclusions  result  from  the  use  of  crude  statistics  which,  generally 
speaking,  are  not  comparable.  The  term  "Jews"  for  statistical 
purposes  is,  as  a  rule,  inclusive  of  all  persons  of  the  Hebrew  faith. 

147 


TEE  MORTALITY  FROM  CANCER 

The  ethnic  and  social  status  of  the  Jewish  population  throughout  the 
world,  however,  varies  enormously.  The  extremes  of  poverty  and 
wealth  are  probably  greater  among  the  Jews  than  among  any  other 
people.  It  is  self-evident  that  the  mortality  statistics  of  Jews  typical 
of  the  Ghetto  type  are  not  strictly  comparable  with  the  statistics 
of  the  Jewish  population  of  modern  cities,  like  New  York,  where  they 
enjoy  a  considerable  degree  of  material  well-being.  Physically  the 
Hebrews  of  to-day  are  European  or  Aryan  rather  than  Semitic.  It 
has  properly  been  observed  that  "the  Hebrew  is  a  mixed  race,  like 
all  our  immigrant  races  or  peoples,  although  to  a  less  degree  than 
most."  The  Jewish  people  are  divided  into  two  chief  divisions:  first, 
the  northern  type,  or  Ashkenazim,  and  second,  the  southern,  or  Se- 
phardim,  also  called  Spanish  Jews.  The  Jews  have  mixed  or  inter- 
married to  a  considerable  degree  with  all  the  races  among  whom  they 
have  settled.  The  Russian  Jew  represents,  as  a  class,  quite  a  different 
physical  type  from  the  average  American  Jew.  The  mortality 
statistics  of  the  Jews  of  Warsaw  and  Budapest  are,  therefore,  not 
exactly  comparable  with  the  mortality  statistics  of  the  Jews  of  the 
United  States.  It  is  necessary  to  keep  these  facts  in  mind  to  give 
due  weight  to  the  available  data  regarding  cancer  occurrence  among 
the  different  elements  of  the  Jewish  population. 

Fishberg  in  his  treatise  on  the  Jews,  with  reference  to  pathological 
characteristics,  refers  to  a  curious  statement  by  Lombroso,  that  the 
proportion  of  deaths  from  cancer  was  2  per  cent,  for  the  general 
population,  against  3.3  per  cent,  for  Italian  Jews.  He  quotes  Braith- 
waite  as  having  noticed  "that  cancer  of  the  uterus  was  seldom  or  never 
encountered  among  the  numerous  Jewesses  attending  the  outdoor 
department  of  the  Leeds  General  Infirmary."  According  to  the  same 
author,  a  writer  in  the  British  Medical  Journal  (March  15,  1902)  has 
stated  that  in  his  experience  cancer  of  the  breast,  was  often  met  with 
among  Jewesses  in  London.  Fishberg  himself  is  responsible  for  the 
view  that  "the  mortality  from  cancer  among  the  Russian  Jewish 
immigrants  in  New  York  City  is  much  below  that  of  the  non- 
Jewish  population."  But  on  the  basis  of  a  study  of  the  reports  of  a 
large  Jewish  and  of  a  large  Christian  hospital  in  New  York  City,  he 
concludes  that  "cancer  is  by  no  means  rare  among  them,  although  less 
common  than  among  non-Jews,"  and  he  adds  that  "sarcoma  appears 
to  be  more  frequent  among  the  Jews,  while  cancer  of  the  breast,  and 
especially  of  the  uterus,  is  less  frequently  met  with  among  them." 

The  subject  is  reviewed  by  Wolff  at  considerable  length.  The 
consensus  of  qualified  opinion  would  seem  to  favor  the  conclusion  that 
cancer  is  proportionately  less  common  among  Jews  than  among 
Gentiles  and  that  cancer  of  the  uterus  is  rare.  The  most  instructive 
data  on  the  subject  have  been  brought  together  by  Theilhaber,  who 
calls  especial  attention  to  the  rarity  of  cancer  of  the  uterus  among 
Jewesses,  and  in  contrast  thereto  the  relative  frequency  of  non-malig- 
nant fibroid  uterine  tumors.  According  to  the  official  statistics  of 
Munich,  as  quoted  by  Kirschner,  the  mortality  from  cancer  of  the 
uterus  among  Jewesses  is  much  below  the  average  in  that  city.* 

*The  cancer  statistics  for  Munich  for  Christian  and  Jewish  women  are  given  in  Table  120,  Appendix  G. 

148 


OBSERVATIONS  AND  CONCLUSIONS 

Auerbach's  statistics  for  Budapest,  apparently  derived  from  official 
sources,  show  that  the  general  mortality  from  cancer  was  about  the 
same  for  Jews  and  Catholics,  but  the  rate  for  cancer  of  the  uterus  was 
only  8.6  per  100,000  for  Jewesses,  against  24.0  for  Catholics,  and  26.0 
for  other  confessions.  In  contrast  the  statistics  of  Munich  appear  to 
prove  that  cancer  of  the  breast  is  relatively  more  common  among 
Jewesses  than  among  women  of  the  Christian  faith.  It  is  regrettable 
that  the  available  data  have  not  been  subjected  to  a  thorough  critical 
analysis.  Dr.  Felix  Theilhaber  of  Munich,  in  a  contribution  to  the 
periodical  on  Jewish  Demography  (March,  1910)  restates  these  conclu- 
sions, largely  on  the  basis  of  the  statistics  of  Budapest,  to  the  effect  that 
while  normally  cancer  of  the  uterus  accounts  for  about  35  per  cent, 
of  the  mortality  from  cancer  among  women,  and  nowhere  much  less 
than  25  per  cent.,  the  proportion  for  the  Jewesses  of  Budapest  was 
at  most  10  per  cent.  He  adds  the  interesting  observation  that  this 
rarity  may  be  attributable  to  the  apparently  more  normal  or 
abundant  blood  supply  of  the  generative  organs  among  Jewesses,  in 
contrast  to  the  more  or  less  abnormal  and  anaemic  conditions  met 
with  among  Christian  women  of  the  temperate  zone.  He  quotes 
Steinhelm  to  the  effect  that  during  a  practice  of  35  years  among  the 
poor  of  a  city  with  from  25,000  to  30,000  inhabitants,  including  all 
classes,  he  had  never  met  with  a  single  case  of  cancer  of  the  uterus 
among  Jewesses ! 

Fishberg  has  advanced  the  opinion  that  the  same  view  is  held  by 
leading  gynecologists  of  New  York  City.  He  makes  the  additional 
statement  that  "It  is  well  known  that  carcinoma  of  the  uterus  is 
more  often  met  with  in  women  who  have  given  birth  to  children  than 
in  sterile  women,  and  Jewesses  only  rarely  remain  single."  Regard- 
less of  their  higher  fecundity  the  Jewesses  are  apparently  less  liable  to 
cancer  of  the  generative  organs.  He  adds,  "What  the  cause  is  of  this 
peculiarity,  whether  it  is  due  to  some  peculiarity  of  the  ritual  dietary 
laws,  or  anything  else,  cannot  even  be  conjectured  as  long  as  we  are 
ignorant  of  the  cause  of  cancer,"  and  he  therefore  concludes  that  "At 
any  rate,  this  seems  to  be  an  important  field  for  investigation  which 
may  throw  some  light  on  the  etiology  of  cancer."* 

It  has  not  been  feasible  on  the  present  occasion  to  make  an  original 
statistical  study  of  the  comparative  frequency  of  cancer  among  the 
Jewish  and  the  non-Jewish  population.  Knopfel  of  Darmstadt  has 
brought  together  the  data  for  a  period  of  years,  with  a  due  regard  to  age 
and  sex,  and  it  is  shown  that  for  all  ages  the  comparative  mortality  from 
cancer  of  the  Jews  exceeds  the  comparative  mortality  of  Christians,  but 
especially  so  at  ages  70  and  over.  At  all  ages  the  cancer  death  rate  of 
Christian  males  was  88  per  100,000,  compared  with  119  for  male  Jews; 
and  for  Christian  females,  116  compared  with  177  for  Jewesses.  These 
statistics  are  representative  of  the  Jewish  population  of  the  Grand  Duchy 
of  Hesse.  In  Appendix  G,  on  the  Cancer  Mortality  in  Foreign  Coun- 
tries, two  tables  are  included  for  the  Jewish  population  of  Vienna.  These 
tables  indicate  a  high  cancer  death  rate  on  the  basis  of  the  estimated 
population  and  a  high  proportionate  mortality  from  cancer  on  the  basis 

*Maurice  Fishberg,  "The  Jews,"  New  York,  1911. 

149 


THE  MORTALITY  FROM  CANCER 

of  tlie  mortality  from  all  causes,  with,  however,  an  apparent  tendency 
during  very  recent  years  towards  a  diminution  in  frequency  (Tables 
174  and  175,  Appendix  G).  For  Budapest  it  is  shown  that  the 
proportionate  mortality  from  cancer  was  5.44  per  cent,  for  the  non- 
Jewish  population,  against  7.01  per  cent,  for  the  Jews;  but  cancer  of 
the  uterus  occurred  in  the  proportion  of  20.2  per  cent,  of  the  total 
mortahty  from  cancer  among  non-Jews,  against  only  7.7  per  cent,  for 
Jews.  The  statistics  of  Holland  confirm  this  experience,  for  the  pro- 
portion of  cancer  deaths  in  the  mortality  from  all  causes  in 
Amsterdam  was  5.Q5  per  cent,  for  Jews,  against  15.19  per  cent,  for 
non-Jews.* 

As  elsewhere  observed,  there  are  many  convincing  reasons  for  be- 
lieving that  cancer  frequency  is  largely  conditioned  by  the  attained 
degree  of  material  well-being,  which  in  a  measure  is  the  equivalent  of  at 
least  a  hypothetical  tendency  to  overnutrition.  In  view  of  the  wide 
degree  of  divergence  in  social  and  economic  status  between  the  Jews  of 
Europe  and  the  Jews  of  America,  it  would  seem  unsafe  to  accept  the 
available  statistical  information  as  entirely  conclusive.  For  a  typical 
Jewish  population  living  in  conformity  to  the  ritual  there  would,  how- 
ever, seem  to  be  no  question  but  that  among  this  class  cancer  in 
general  is  rare  and  that  cancer  of  the  uterus  is  exceptionally  uncommon. 
Unfortunately,  as  observed  by  W.  R.  Williams,  "Although  the  compar- 
ative pathology  of  the  Jew  has  been  fully  worked  out  for  most  diseases, 
with  regard  to  malignant  tumors  the  data  are  scanty  and  leave  much 
to  be  desired."  But  his  conclusion  would  seem  to  be  sound,  that  "on 
the  whole,  however,  the  available  indications  point  clearly  to  the  con- 
clusion that  the  liability  of  Jews  to  cancer  varies  with  their  mode  of  life, 
approximating  to  that  of  the  people  among  whom  they  dwell,  but  gen- 
erally being  somewhat  inferior  to  it."  It  should  be  kept  in  mind  that 
the  proportion  of  persons  of  the  cancer  age  is  relatively  larger  among 
Jews  than  among  Gentiles  in  Europe  as  well  as  in  America.  The 
exceptional  longevity  of  the  Jew  is  proverbial,  but  regardless  of  this 
fact  the  proportion  of  deaths  from  cancer  is  generally  below  the 
average. 

The  most  recent  discussion  of  the  comparative  cancer  frequency  among 
Jews  is  found  in  "The  Cancer  Problem,"  by  William  Seaman  Bainbridge. 
The  statistics  are  derived  from  the  Kosher  Wards  of  the  London  Hos- 
pital for  the  year  1911.  Among  males  the  proportion  of  cancer  cases  in 
the  total  admissions  was  5.1  per  cent,  for  Gentiles,  compared  with  3.3 
per  cent,  for  Jews;  among  females,  however,  the  proportionate  figures 
were  6.2  per  cent,  for  Gentiles,  against  6.4  per  cent,  for  Jews.  The 
earlier  conclusion  regarding  the  comparative  infrequency  of  cancer 
of  the  uterus  is  confirmed,  in  that  the  proportion  of  such  cancer  cases 
among  Gentiles  was  8.6  per  cent.,  as  against  2.9  per  cent.for  Jews. 

As  said  before,  all  statistics  at  present  available  are  more  or  less  con- 
tradictory and  inconclusive,  but  the  negative  aspect  of  the  evidence  is 
fairly  convincing,  that  cancer  is  relatively  less  common  among  Jews 
living  in  conformity  to  the  orthodox  principles  of  their  faith,  and  that 

•Mortalite  par  Cancer  a  Amsterdam  pendant  les  annees  1862-1902,  par  Feu  Le  Dr.  J.  J.  Van  Konijnenburg, 
Amsterdam,  1911. 

150 


OBSERVATIONS  AND  CONCLUSIONS 

under  normal  conditions  of  life  tliey  are  less  liable  to  the  disease, 
possibly  because  of  their  poverty  and  simple  mode  of  living, 
especially  to  cancer  of  the  uterus,  than  Gentiles  of  corresponding  social 
and  economic  status.* 

Cancer  among  the  North  American  Indians 
Malignant  disease  among  North  American  Indians  appears  to  be  ex- 
tremely rare.  A  special  study  of  the  question  made  by  Dr.  Isaac  Levin  in 
behalf  of  the  George  Crocker  Special  Research  Fund,  with  the  approval 
of  the  Commissioner  of  Indian  Affairs,  brought  out  the  fact  that  among 
an  Indian  population  of  115,000  there  had  been  only  29  reported  cases 
of  cancer  in  the  entire  medical  practice  of  107  agency  physicians,  ranging 
from  an  experience  of  a  few  months  to  over  20  years.  As  observed  by 
Dr.  Levin  in  a  paper  on  "Cancer  among  the  North  American  Indians 
and  Its  Bearing  upon  the  Ethnological  Distribution  of  the  Disease," 
contributed  to  the  Studies  in  Cancer  and  Allied  Subjects  of  the  George 
Crocker  Special  Research  Fund  (New  York,  1912),  "Cancer  is  ex- 
tremely rare  among  the  Indians  as  compared  with  the  whites  of  the  same 
locality,  since  according  to  the  twelfth  census  cancer  is  just  as  frequent 
among  the  whites  of  the  states  in  which  the  Indian  reservations  are 
located  as  in  other  states,"  and  thus  "the  conclusion  must  be  reached 
that  while  it  may  be  true  that  cancer  prevails  among  all  the  races  of 
mankind,  it  is  also  true  that  the  American  Indians  living  under  the  same 
geographical  and  climatic  conditions  as  their  white  neighbors  may  be 
actually  nearly  immune  from  the  disease." 

The  infrequency  of  cancer  among  the  North  American  Indians  can 
not  be  attributed  to  a  lower  proportion  of  persons  of  the  cancer  age, 
since  according  to  the  approximately  accurate  data  of  the  thirteenth 
census  the  proportion  of  Indians  ages  50  and  over  was  13.6  per  cent.,  in 
comparison  with  12.3  per  cent,  for  the  native  white  population  and  10.4 
per  cent,  for  the  negro.  In  the  census  year  1910  there  were  886  deaths 
from  all  causes  enumerated  among  Indians  living  in  the  registration 
area,  but  of  this  number  only  9,  or  1.0  per  cent.,  were  deaths  from 
cancer  and  other  malignant  tumors. 

The  extreme  rarity  of  cancer  among  North  American  Indians  is 
further  confirmed  by  a  recent  inquiry  of  my  own,  made  with  the  approval 
of  the  Commissioner  of  Indian  Affairs,  inclusive  of  many  different 
tribes,  living  in  17  different  states.  The  replies  received  from  agency 
physicians  concern  a  full-blood  population  of  52,240  and  a  mixed-blood 
population  of  10,632.  Among  some  63,000  Indians  of  all  tribes,  liv- 
ing under  a  variety  of  social,  economic  and  climatic  conditions,  there 
occurred  only  2  deaths  from  cancer  as  medically  observed  during  the 
year  1914.  The  available  evidence  is  therefore  quite  conclusive  that 
malignant  disease  is  of  extremely  rare  occurrence  among  the  native 
Indian  population  of  the  United  States,  and  the  infrequency  of  the  dis- 
ease suggests  the  practical  importance  of  further  research  into  the  under- 
lying causes  or  conditioning  circumstances  of  their  apparent  immunity, 
as  the  case  may  be. 

*See  in  this  connection  a  discussion  of  the  comparative  frequency  of  cancer  according  to  religion  and 
language  in  Hungary  and  Budapest,  in  "Statistik  der  Krebskranken  in  den  Landern  der  Ungarischen  Heil. 
Krone,"  by  Dr.  Julius  Dollinger,  Budapest,  1908. 

151 


THE  MORTALITY  FROM  CANCER 

Of  much  interest  in  this  connection  are  the  exceptionally  valuable 
"Physiological  and  Medical  Observations  among  the  Indians  of  South- 
western United  States  and  Northern  Mexico,"  by  Ales  Hrdlicka  (Bulle- 
tin No.  34,  Bureau  of  American  Ethnology,  Washington,  1908).  After 
an  extended  inquiry  Dr.  Hrdlicka  remarks  that  "Malignant  diseases, 
if  they  exist  at  all — that  they  do  would  be  difficult  to  doubt — must  be 
extremely  rare.  The  writer  heard  of  'tumors'  and  saw  several  cases  of 
the  fibroid  variety,  but  has  never  come  across  a  clear  case  of  epithelioma 
or  other  cancer;  nor  has  he  as  yet  encountered  unequivocal  signs  of  a 
malignant  growth  on  an  Indian  bone."  That  malignant  disease  occa- 
sionally occurs  among  North  American  Indians  is  not  to  be  questioned, 
but  the  evidence  would  seem  to  be  entirely  conclusive  that  cancer  is 
very  rare  among  both  the  full-bloods  and  the  mixed-bloods  of  all  our 
Indian  tribes. 

Cancer  among  Gypsies 

Thus  far  no  effort  appears  to  have  been  made  to  determine  with  even 
approximate  accuracy  the  relative  frequency  of  malignant  disease  among 
Gypsies.  The  mode  of  life  of  this  class  of  people  is  so  exceptional  that 
an  inquiry  into  the  occurrence  of  cancer  among  them  would  make  a 
useful  and  interesting  contribution  to  the  cancer  cause.  It  is  regrettable 
that  the  elaborate  and  otherwise  most  valuable  Hungarian  Gypsy 
Census  of  1892  was  not  made  to  include  statistics  of  mortality  by  cause, 
with  a  due  regard  to  age  and  sex.  A  fair  proportion  of  Gypsies  attain  to 
the  cancer  age,  for  out  of  243,000  Gypsies  enumerated,  15,600  were  60 
years  of  age  and  over.  To  a  not  inconsiderable  extent  they  still  live 
under  extremely  primitive  conditions.  Much  valuable  information 
concerning  their  pathology  should  be  obtainable  by  means  of  a  qualified 
analysis  of  the  experience  data  of  the  General  Hospital  at  Kolozvar, 
where  for  many  years  special  attention  has  been  given  to  post-mortem 
examinations.  It  is  by  means  of  special  investigations  of  this  kind  that 
the  most  useful  contributions  to  the  cancer  cause  are  likely  to  be  made. 

Determinable  Factors  of  Cancer  Frequency 

The  statistically  determinable  factors  which  apparently  materially 
modify  cancer  frequency  are  quite  numerous  though  often  obscure  and 
peculiarly  involved.  In  other  words,  the  cancer  death  rate  is  more  or 
less  modified  by  the  age  distribution  of  the  population;  the  variations 
in  sex  proportion;  the  race;  the  physique;  the  condition  of  health; 
the  occurrence  of  contributory  diseases;  the  climate;  the  soil;  the 
character  of  the  water  supply;  the  habits,  as  regards  intoxicating  drink, 
food,  nutrition;  the  physical  condition,  as  indicated  by  height  and 
weight;  occupation;  the  economic  condition,  as  to  well-being  or 
poverty;  the  mental  condition,  as  regards  a  predisposition  to  worry; 
family  history  or  heredity;  and  the  topographic  features  of  the  environ- 
ment, as  brought  out  in  the  researches  of  Green,  of  Edinburgh.  In  addi- 
tion, there  is  the  important  question  in  regard  to  the  possible  corre- 
lation of  cancer  frequency  in  animals  and  plants,  or  at  least  of  diseases 
similar  thereto,  and  last  but  not  least  the  possibility,  though  not  the  prob- 
ability, of  cancer  in  its  final  analysis  being  infectious  and  therefore  a 
transmissible  disease.     It  would  be  utterly  hopeless  as  a  statistical  and 

152 


OBSERVATIONS  AND  CONCLUSIONS 

mathematical  proposition  to  establish  with  accuracy  and  completeness 
the  precise  correlation  and  relative  importance  of  these  numerous  but 
specific  elementary  factors,  all  of  which  apparently  have  some  bearing 
upon  the  rate  of  cancer  frequency  among  the  different  types  of  mankind 
and  throughout  the  different  countries  and  localities  of  the  world. 

Problem  of  Senility 
The  statement  is  frequently  made  that  cancer  is  primarily  a  function  of 
age;  but  as  elsewhere  pointed  out,  it  would  be  more  correct  to  say  that 
cancer  is  a  function  of  senility,  and  even  presenility,  as  made  evident  by 
the  more  common  occurrence  of  sarcoma  among  the  young.  In  the 
Industrial  mortality  experience  of  The  Prudential  the  proportion  of 
deaths  from  sarcoma  at  ages  under  30  was  27.9  per  cent,  of  the  total 
mortality  from  sarcoma,  whereas  the  corresponding  proportion  for  deaths 
from  cancer  was  only  3.2  per  cent.  It  has  properly  been  observed  in  this 
connection  by  Hastings  Gilford,  in  his  treatise  on  "The  Disorders  of  Post- 
Natal  Growth  and  Development." 

Just  as  innocent  tumors  show  themselves  to  be  true  errors  of  growth  by  terminating  at 
some  period  of  their  career,  so  the  malignant  tumors  indicate  that  they  are  errors  of  de- 
velopment by  continuing,  like  normal  developments,  while  life  lasts.  .  .  .  The 
carcinomata  and  sarcomata  are  not,  like  the  innocent  tumors,  mere  passive  accumulations 
of  piled-up  cells,  but  are  aggressive,  actively  invading  other  parts  of  the  body  from  those 
in  which  they  start.  In  this  way  they  usiu^p  the  nutrition  of  the  body,  and  by  means  of 
toxins  or  in  some  mysterious  manner  sap  its  vitality,  causing  the  whole  organism  to  become 
thin  and  exhausted,  finally  bringing  about  its  destruction.* 

Physical  Condition  of  Cancer  Patients 
Perhaps  the  most  perplexing  aspect  of  the  cancer  problem  individually 
considered  is  the  marked  contrast  of  the  physical  condition  of  the 
patient  during  the  onset  and  at  the  termination  of  the  disease.  The 
authorities  are  apparently  in  entire  agreement  that  cancer  is  more 
likely  to  occur  among  persons  otherwise  thoroughly  healthy  than 
among  those  of  a  delicate  or  non-robust  type.  As  shown  by  the  results 
of  the  Medico-Actuarial  Investigation,  the  cancer  mortality  rate  is 
distinctly  higher  among  persons  of  overweight,  and  the  inference  would 
seem  justified  that  at  least  one  of  the  predisposing  factors  in  cancer 
frequency  is  overnutrition  rather  than  malnutrition.  Many  years  ago 
Dr.  John  Zachariah  Laurence,  in  the  Liston  Prize  Essay  for  1854,  on 
"The  Diagnosis  of  Surgical  Cancer,"  observed  that  "the  previous  health 
of  the  patient  gives  us  but  little  information.  As  a  rule,  it  will  be  found 
that  cancerous  patients  have  been  otherwise  remarkably  free  from  dis- 
ease."! He  quotes  twenty-one  cases  in  which  he  had  noted  the  previous 
health,  and  in  sixteen  it  had  been  "unimpeachable,"  and  in  the  remaining 
five,  "any  previous  illness  the  patients  may  have  had  had  been  but  of  a 
transitory  nature."  This  view  is  confirmed  by  one  of  the  most  recent 
authorities  on  tumors  of  the  abdominal  viscera,  who  holds  as  regards 
constitutional  peculiarities  that  "as  far  as  cases  in  advanced  age  are 

*There  is  a  rather  suggestive  discussion  of  the  mortality  from  cancer  in  extreme  old  age  in  the  new  edition 
of  the  "Reference  Handbook  of  the  Medical  Sciences,"  New  York,  1913,  Vol.  ii,  p.  596. 

f'Mice  in  poor  condition  do  not  offer  so  favorable  a  soil  for  tumor  growth  as  do  healthy  ones,  according  to 
Bashford  and  Haaland.  This  may  serve  to  explain  the  results  of  those  who  have  described  the  attainment  of 
resistance  by  treatment  with  autolyzed  tissues,  since  the  possibility  of  sepsis  in  the  animals  of  such  experiments 
ha  snot  been  eliminated."  ("Studies  in  Cancer  and  Allied  Subjects,"  by  the  George  Crocker  Special  Research 
Fund,  Vol.  i,  pp.  137,  200.) 

153 


THE  MORTALITY  FROM  CANCER 

concerned,  they  are  mostly  individuals  of  very  robust  constitution  who 
were  never  sick;  had  but  little  if  any  infectious  diseases;  had  never  been 
troubled  with  disturbances  of  digestion,  and  in  most  instances  came 
from  very  healthy,  long-lived  families.  They  are  in  many  ways  indi- 
viduals in  whose  cases  one  would  be  tempted  to  speak  of  'excessive  well- 
being,'  which,  for  that  matter,  may  amount  to  a  cause,  owing  to  the 
fact  that  such  persons  are  able  to  expose  themselves  much  more  to 
dietetic  indiscriminations  without  harmful  results  for  a  long  time."  As 
regards  cancer  at  younger  ages,  that  is,  say  between  30  and  40  years,  the 
author  observes  that  the  reverse  is  true,  and  that  in  this  group  the 
patients  frequently  are  individuals  inclined  to  weakness  and  have  a 
general  aspect  that  is  decidedly  phthisical,  pallor  of  the  face,  etc.  He 
further  points  out  that  this  class  of  individuals  are  most  likely  to  become 
afflicted  with  lympho-sarcomatous  processes.*  W.  R.  Williams,  in  his 
"Natural  History  of  Cancer,"  referring  especially  to  cancer  of  the  uterus, 
remarks  that  "the  great  majority  of  such  persons  whose  life  history  he 
had  investigated  had  been  well-fed  and  well-housed,  having  had  nothing 
to  do  but  to  look  after  their  own  domestic  establishment.  They  bad 
usually  enjoyed  excellent  health,  most  of  them  having  had  no  serious 
illness  since  youth,  rheumatic  fever  and  rheumatism  being  the  com- 
monest diseases  from  which  they  had  suffered."  Elsewhere  in  his  work 
the  same  author  observes  that  "cancer  is  a  disease  of  persons  whose 
previous  life  has  been  healthy  and  whose  nutritive  vigor  seems  to  promise 
long  life.  Long-continued  observation  of  cancer  patients  in  the  early 
stage  of  the  disease  has  convinced  me  that  most  of  those  affected  are 
large,  well-nourished  persons  who  appear  to  be  overflowing  with  vitality  .f 
Such  types  are  indicative  of  hypernutrition.  The  small,  pale,  ill- 
nourished  and  overworked  women  of  the  type  so  familiar  in  Lancashire 
and  other  industrial  centers,  are  seldom  afflicted  with  this  disease." 
Some  forty  years  earlier  Charles  H.  Moore,  in  several  contributions  to  the 
British  Medical  Journal,  gave  utterance  to  much  the  same  conclusions, 
stating  that  cancer  was  chiefly  a  disease  of  healthy  and  strong  persons, 
to  which  he  adds  the  curious  and  interesting  observation,  subsequently 
neither  confirmed  nor  reinvestigated,  that  cancer  was  more  common 
among  the  first-born.  These  observations  are  of  profound  significance 
in  connection  with  the  objects  and  aims  of  a  nation-wide  effort  at  cancer 
control,  which,  in  brief,  amounts  to  no  more  and  no  less  than  the  de- 
liberate reduction  of  the  cancer  death  rate,  on  the  basis  of  the  earliest 
possible  diagnosis  and  the  prompt  recourse  to  approved  methods  of  treat- 
ment and  cure.  It  is  notoriously  the  healthy  and  the  strong  who  are 
least  willing  to  concede  the  latent  possibility  of  early  death.     It  is  this 

*Rudolph  Schmidt,  "Diagnosis  of  the  Malignant  Tumors  of  the  Abdominal  Viscera,"  p.  50,  English  trans- 
lation by  Joseph  Burke,  New  York,  1913. 

fSome  very  interesting  investigations  have  been  made  by  Miss  E.  Atlee,  regarding  the  maximum  of  the 
lifetime  weight  curve  of  uterine  cancer  patients.  The  results  of  her  researches  are  summed  up  in  the  statement 
that  body  weight  attains  to  its  maximum  during  the  years  immediately  preceding  the  onset  of  the  disease,  and 
that  health  and  strength  remained  normal  during  the  same  period.  In  the  case  of  controls  (women  suffering 
from  other  forms  of  malignant  disease)  it  was  found  that  the  body  weight  had  been  at  its  maximum,  not  during 
the  years  immediately  preceding  the  appearance  of  the  disease,  but  much  earlier  in  life,  at  which  time  health  and 
strength,  though  maximum,  had  not  been  necessarily  normal.  The  investigation  was  apparently  not  carried 
through  with  complete  facilities  for  statistical  analysis.  The  line  of  inquiry,  however,  would  seem  to  suggest 
possibilities  of  practical  value  in  suggesting  a  means  of  an  early  diagnosis  of  at  least  uterine  cancer,  and  event- 
ually perhaps  throw  new  light  on  the  cancer  question  in  general. 

154 


OBSERVATIONS  AND  CONCLUSIONS 

class  which  is  most  optimistic  and  least  apprehensive  when  first  con- 
fronted by  faint  signs  or  indications  of  more  or  less  obscure  forms  of 
physiological  disturbances.  Since  cancerous  growths  are  without 
nerves,  pain  is  absent,  as  a  rule,  until  the  growth  has  attained  to  suffi- 
cient proportion  to  press  by  its  weight  upon  adjacent  parts  and  thus 
produce  a  sense  of  discomfort,  which  is  frequently  assumed  to  be  but  a 
passing  phenomenon,  and,  in  any  event,  one  which  as  a  rule  does  not 
suggest  serious  future  possibilities. 

Problem  of  Growth  and  Development 

Innumerable  and  varied  indeed  are  the  alleged  causes  or  conditioning 
circumstances  of  malignant  disease.  In  its  final  analysis  the  problem  of 
cancer  becomes  merged  with  the  problem  of  life,  growth,  development 
and  death.  In  the  vast  domain  of  medicine  there  is  no  other  disease 
which  resembles  it  in  its  essential  manifestations  and  obstinate  resistance 
to  treatment  other  than  by  radical  methods.  The  term  cancer  is  used  here 
in  the  generic  sense*  merely  as  a  matter  of  convenience,  for  even  the 
most  painstaking  classification  fails  in  rare  individual  cases,  since 
exceptions  to  established  rules,  according  to  Miller,  "are  so  frequently 
met  with  in  relation  to  neoplasms,  that  the  most  elaborate  system 
breaks  down  at  many  points,  unless  each  tumor  be  placed  in  a  category 
by  itself."  Charles  Powell  White  has  directed  attention  to  the  analogous 
cases  of  mutations  and  bodily  variations  which  play  such  an  important 
part  in  biology. 

Precancerous  Conditions 

Precancerous  conditions,  as  defined  by  Rodman,  may  be  internal  as 
well  as  external;  and  moreover,  it  is,  to  say  the  least,  suggestive  that 
"such  precancerous  conditions  are  inflammatory,  inasmuch  as  a  mild, 
low-grade  chronic  inflammation,  due  to  long  standing  irritation  and 
resulting  in  either  ulceration,  hyperplasia,  or  cicatricial  tissue  is  present 
in  all  of  them,"  and  "this  in  turn  means  diminished  arterial  supply 
with  lessened  physiologic  resistance  of  the  cells  undergoing  metaplasia, 
and  while  there  may  be  in  addition  something  more  necessary,  extrinsic 
or  intrinsic,  to  initiate  the  cancer  process  this  much  is  always  present, 
a  suitable  soil,  if  you  please,  and  would  seem  enough  in  itself  to  cause 
cancer."t  Foremost  among  precancerous  conditions,  according  to 
Parker  Syms,  are  benign  tumors,  chronic  ulceration,  chronic  inflamma- 
tion, and  abnormal  tissue,  such  as  scars,  and  prolonged  irritation.  The 
experience  and  researches  of  Keen  and  Bloodgpod  are  referred  to  as 
tending  to  prove,  with  reference  to  pigmented  moles,  that  these  growths 
are  prone  to  become  cancerous,  and  an  enumeration  is  made  of  sixty- 
five  cases  of  malignant  moles  operated  upon,  in  every  case  of  which  the 
diagnosis  was  confirmed  by  microscopic  examination.  But,  by  way  of 
contrast,  seventy-six  other  cases  of  benign  pigmented  moles  are  cited, 
which  "were  removed  in  the  precancerous  stage,"  and  with  regard  to 
which  it  is  stated  that  "there  have  been  no  local  recurrences  and  no 
deaths  from  internal  metastases."! 

*The  clinical  characters  of  cancer  as  a  basis  for  classification  is  fully  discussed  in  a  lecture  on  "The  Biology 
nf  Tumors,"  by  C.  Mansell  Moullin,  M.  D.,  in  The  Lancet,  March  21,  1914.  See  also  page  166,  et  seq.,  on  the 
degree  of  malignancy,  rapidity  of  growth  and  clinical  signs. 

tAnnals  of  Surgery,  January,  1914. 

IMedical  Record,  May  17, 1913. 

155 


THE  MORTALITY  FROM  CANCER 

The  exact  correlation  of  cancer  to  other  diseases  has  not  been 
established,  but  qualified  investigations  in  this  direction  would  un- 
questionably prove  productive  of  valuable  results.  The  data  require 
to  be  considered  with  extreme  caution,  and  in  many  cases  correction  will 
be  necessary  for  variations  in  sex  and  age  distribution,  and  possibly  other 
conditioning  circumstances.  Such  investigations  should  be  carried  on 
in  connection  with  the  more  minute  study  of  the  anatomical  findings  in 
trustworthy  autopsy  records,  by  means  of  which  the  primary  lesions  of 
cancerous  growth  may  be  precisely  determined. 

Carcinomata,  according  to  Miller,  "occur  (1)  at  or  near  the  orifices 
of  the  body — lip,  tongue,  rectum,  vagina;  (2)  at  points  where  normally 
there  is  narrowing  of  a  canal — pylorus,  ileo-caecal  valve;  (3)  at  points 
where  a  canal  changes  its  direction — ^hepatic,  splenic,  sigmoid  flexures 
of  large  intestine;  (4)  in  glands  such  as  the  mammary,  and  in  organs 
such  as  the  uterus,  which  are  periodically  undergoing  hypertrophy  and 
involution.  In  other  words,  there  is  a  marked  association  of  cancer 
with  chronic  irritation  of  various  kinds."*  The  term  irritation  is  used 
here  in  a  very  general  sense.  The  irritation  need  not  necessarily  be 
mechanical,  but  may  be  purely  physiological  or  pathological  or  even 
chemical  or  in  the  nature  of  overstimulation  of  physiological  functions 
incident  to  metabolism. 

Gastric  Ulcers  and  Gall-stones 

As  of  special  interest  in  connection  with  this  brief  dicussion  of  pre- 
cancerous conditions,  a  reference  may  be  made  to  gastric  ulcers  and 
gall-stones.  In  the  experience  of  the  Mayo  clinic,  Rochester,  Minne- 
sota, "it  has  been  shown  that  between  60  and  70  per  cent,  of  cancers 
of  the  stomach  have  developed  in  the  site  of  a  preexisting  gastric  ulcer,t 
or  in  the  cicatrix  of  an  ulcer  which  had  been  healed,"  and  the  conclusion 
is  therefore  confirmed  by  Parker  Syms  that  "we  must  consider  gastric 
ulcer  as  a  precancerous  stage  of  more  than  two-thirds  of  the  gastric 
cancers."  Concerning  gall-stones  as  a  predisposing  condition,  the  same 
authority  concludes  that  "in  practically  100  per  cent,  of  cases  of  primary 
cancer  of  the  gall  bladder  and  bile  ducts  gall-stones  may  be  found,  and 
it  may  be  demonstrated  that  they  have  existed  for  a  long  period  before 
a  cancer  developed."  J.  Bland-Sutton,  in  a  brief  discussion  of  cancer 
of  the  gall-bladder,  in  his  treatise  on  "Gail-Stones  and  Diseases  of  the 
Bile-Ducts,"  remarks  that  "this  disease  [cancer]  has  in  recent  years  at- 
tracted a  large  amount  of  attention;  this  is  in  a  measure  due  to  its  in- 
timate association  with  gall-stones,  though  this  fact  has  long  been  recog- 
nised. .  .  .  Careful  investigations  on  this  point  prove  that  in  at  least 
95  per  cent,  of  cases  gall-stones  are  present,  and  this  has  induced 
surgeons  to  regard  the  presence  of  biliary  concretion  in  the  gall-bladder 
as  a  precancerous  condition.  It  is,  however,  a  curious  fact,  and  one 
worth  bearing  in  mind,  that  although  cancer  of  the  gall-bladder  is 
nearly  always  complicated  with  gall-stones,  this  association  is  quite 
exceptional  when  primary  cancer  arises  in  the  common  bile-duct  or  the 
ampulla."     The  special  importance  from  a  statistical  point  of  view  of 

•James  Miller,  "Practical  Pathology,  including  Post-Mortem  Technique,"  New  York,  1914,  p.  297. 

fit  may  be  properly  stated  in  this  connection  that  Dr.  Wm.  L.  Rodman  is  generally  credited  by  the 
medical  profession  as  having  been  the  first  toadvise  the  removal  of  gastric  ulcers  on  account  of  the  inherent 
tendency  to  degenerate  into  malignant  affections. 

156 


OBSERVATIONS  AND  CONCLUSIONS 

this  observation  lies  in  the  fact  that  there  has  been  a  decided  increase 
in  the  frequency  of  gall-stone  mortality  in  certain  civilized  countries, 
corresponding  more  or  less  to  the  increase  in  the  mortality  from  cancer. 

Prognosis  of  Precancerous  Lesions 
Important  practical  consequences  must  necessarily  result  from  a 
general  acceptance  of  the  doctrine  of  precancerous  lesions.  It,  of 
course,  does  not  necessarily  follow  that  the  discovery  of  such  lesions 
assures  in  every  instance  that  the  process  is  likely  to  terminate  in  a 
cancerous  growth;  but  the  indications  are  invariably  of  profound  prog- 
nostic significance.  As  observed  by  Ewing,*  "If  inoperable  advanced 
cancer  is  incurable,  and  localized  cancer  eradicable,  the  disease  is  pre- 
ventable by  dealing  with  its  preliminary  stages.  Precancerous  lesions 
are  not  cancers.  Practically  they  differ  enormously  from  the  estab- 
lished disease.  They  can  usually  be  removed  by  trivial  or  safe  opera- 
tions, and  they  are  sometimes  amenable  to  less  violent  treatment." 
"Gastric  ulcers,  lingual  warts,  fissures,  and  plaques,  eroded  cervices, 
pigmented  moles,  and  benign  tumors,  are  everywhere  excised,"  accord- 
ing to  this  writer,  "with  the  conviction  that  a  malignant  tumor  may 
thereby  be  prevented,  but  the  relation  between  the  benign  and  the 
malignant  process  is  still  under  discussion  and  often  frankly  doubted." 

Uterine  Cancer 

The  recognition  of  precancerous  conditions  would  appear  to  be  of 
especial  importance  in  the  case  of  cancer  of  the  uterus.  According  to 
Parker  Syms,  "there  are  many  conditions  which  predispose  to  these 
cancers,  such  as  simple  tumors  of  the  uterus,  chronic  inflammation 
of  the  organ,  and  chronic  ulceration,  or  so-called  erosion,  usually 
the  result  of  neglected  laceration  and  tears."  The  conclusion  would 
therefore  seem  justifiable  that  "All  these  abnormalities  should  be 
remedied  because  they  are  precursors  of  cancer."  In  the  uterus,  as 
stated  by  Ewing,  chronic  catarrhal  endocervicitis  precedes  cancer  in 
the  great  majority  of  cases,  and  the  cervical  erosion  is  the  most  definitely 
established  lesion  known  to  precede  cervical  carcinoma.  In  the  case 
of  the  body  of  the  uterus  the  chief  definite  etiological  factor,  according 
to  the  same  authority,  is  the  association  with  myoma,  which  is  a  tumor 
composed  of  mucular  tissue,  or  a  tissue  of  the  same  nature  as  the  con- 
nective tissue  of  the  embryo  and  of  the  umbilical  cord,  and  vitreous 
humor.  This  tumor  is  not  malignant  in  itself,  but  there  is  apparently 
a  well-established  liability  of  its  assuming  a  cancerous  form. 

Considerations  of  this  nature  are  extremely  involved  pathological  and 
medical  problems,  which  hardly,  as  yet,  permit  of  being  subjected  to 
qualified  statistical  analysis.  The  references  are  included  as  illustrations 
of  perhaps  the  most  important  phase  of  the  cancer  problem  individually 
considered;  since  in  proportion  as  the  laity  can  be  made  to  recognize 
the  value  to  be  attached  to  precancerous  lesions,  the  outlook  for  suc- 
cessful medical  and  surgical  treatment  must  be  materially  increased. 

Difficulties  of  Early  Diagnosis 

In  this  connection  the  following  observations  by  Dr.  Thomas  S. 
Cullen  are  of  especial  interest.     As  regards  cancer  of  the  tongue,  Dr. 

*J.  Ewing,  M.  D.,  "Precancerous  Diseases,"  Medical  Record,  December  5, 1914. 

157 


TEE  MORTALITY  FROM  CANCER 

Cullen  points  out  that  the  milky  patches  on  the  tongue  of  smokers, 
if  removed  at  once,  would  result  in  no  further  trouble;  but  if  one  waited 
without  interference  carcinoma  would  unquestionably  develop.  In 
carcinoma  of  the  lip,  if  the  radical  operation  were  performed,  the  chances 
of  complete  recovery  would  be  considered  good.  In  carcinoma  of  the 
stomach,  pathology  did  not  as  yet  aid  very  much,  and  if  one  waited 
for  the  stomach-washings  to  show  the  characteristic  lesions  as  a  pre- 
requisite to  a  correct  diagnosis,  it  would  usually  be  so  late  in  the  course 
of  the  disease  that  little  could  be  done  for  the  patient.  It  is  therefore 
suggested  that  an  exploratory  operation  should  be  made  to  determine 
whether  cancer  was  present  or  not.  The  surgeon,  as  well  as  the  pathol- 
ogist, he  points  out,  was  aided  in  this  respect  by  a  fluoroscopic  examina- 
tion, which  was  destined  to  play  a  large  role  in  the  making  of  early  diag- 
noses. If  one  were  dealing  with  a  carcinoma  of  the  intestines,  signs  of 
obstruction  appeared  fairly  early,  and  more  and  more  cases  were  now  ap- 
parently cured  by  early  operation.  The  pathology  here  was  quite  char- 
acteristic. Cancer  of  the  rectum  and  lower  sigmoid  could  be  detected 
by  the  proctoscope,  and  by  its  use  many  early  diagnoses  were  now 
made.  In  fact,  with  the  proctoscope  a  diagnosis  was  relatively  easy  in  the 
majority  of  cases.  There  are,  he  concludes,  two  common  types  of 
special  importance,  cancer  of  the  breast  and  cancer  of  the  uterus.  Cancer 
of  the  breast  in  the  early  stages  might  have  been  beneath  the  skin  and 
there  might  not  have  been  any  adhesions  or  puckerings,  but  as  the  disease 
advanced  this  characteristic  puckering  of  the  skin  occurred.  If  one  cut 
into  the  growth  and  removed  a  local  area,  the  portion  could  be  imme- 
diately recognized ;  if  it  proved  to  be  cancerous,  a  complete  and  radical  op- 
eration should  be  done,  together  with  the  removal  of  the  axillary  glands.* 

Cancer  Hospital  Statistics 
It  is  most  regrettable  that  the  statistical  reports  of  cancer  hos- 
pitals should  be  of  such  limited  practical  usefulness.  The  conclusion 
applies  also  to  the  reports  of  the  larger  general  hospitals,  with  the 
exception  of  the  Johns  Hopkins  Hospital  of  Baltimore,  which  for  more 
than  twenty  years  has  published  the  required  statistics  in  sufficient 
detail.  There  is  an  urgent  need  of  a  national  movement  for  uniform 
methods  of  tabulation  and  analysis  of  statistics,  at  least  of  the  larger 
general  hospitals  and  special  institutions  for  the  treatment  of  cancer 
patients.  At  present  the  available  data  can  not  be  utilized  to  much 
practical  value  in  a  statistical  study  of  the  cancer  morbidity  and 
mortality  problem,  with  a  due  regard  to  the  essentials  of  age,  sex,  race 
and  the  organs  and  parts  of  the  body  affected.  To  a  limited  extent,  of 
course,  the  existing  statistics  are  useful,  if  but  to  emphasize  the  fact 
that  in  the  main  the  results  of  institutional  treatment,  at  least  for 
certain  forms  of  cancer,  are  distinctly  encouraging.  The  statistics  of 
the  Charity  Hospital  of  New  Orleans,  for  illustration,  as  given  elsewhere 
in  this  work  show  in  some  detail,  the  results  of  treatment  by  race,  but  the 
data,  unfortunately,  are  not  given  according  to  sex.  In  the  experience 
of  this  notable  institution  during  the  period  1910-14,  for  both  races 
combined,  the  fatality  rate  for  cancer  of  the  buccal  cavity  was  14.8 
per  cent.;  for  cancer  of  the  stomach  and  liver,  44.5  per  cent.;  for  cancer 

*  Medical  Record,  New  York,  April  26, 1913, 

158 


OBSERVATIONS  AND  CONCLUSIONS 

of  the  peritoneum,  intestines  and  rectum,  37.2  per  cent. ;  for  cancer  of  the 
female  generative  organs,  15.9  per  cent.;  for  cancer  of  the  breast,  11.3 
per  cent.;  for  cancer  of  the  skin,  13.1  per  cent.;  and  for  cancer  of  other 
organs,  22.8  per  cent.  For  all  forms  of  cancer  combined,  the  fatality 
rate  was  21.1  per  cent.  For  white  patients,  separately  considered,  the 
fatality  rate  was  21.1  per  cent. ;  for  colored  patients,  20.9  per  cent.  The 
experience  includes  medical,  surgical  and  gynecological  cases.  Of  the 
total  number  of  cancer  patients,  170  were  cases  of  sarcoma,  and  1,349, 
epithelioma  and  other  carcinomas,  including  rodent  ulcer.  The  fatality 
rate  among  sarcoma  cases  was  30.6  per  cent.,  and  among  carcinoma 
cases,  22.0  per  cent. 

In  the  experience  of  the  American  Oncologic  Hospital  of  Philadelphia 
for  the  period  1909-13,  the  fatality  rate  for  cancer  of  the  buccal  cavity 
was  13.2  per  cent.;  for  cancer  of  the  stomach  and  liver,  44.4  per  cent.; 
for  cancer  of  the  peritoneum,  intestines  and  rectum,  16.7  per  cent. ;  for 
cancer  of  the  female  generative  organs,  27.5  per  cent. ;  for  cancer  of  the 
breast,  28.6  per  cent. ;  for  cancer  of  the  skin,  10.2  per  cent. ;  for  cancer  of 
other  organs  and  parts,  25.3  per  cent.;  and  for  all  forms  of  cancer  com- 
bined, 21.7  per  cent.  Out  of  a  total  of  314  cases  of  mahgnant  disease,  19 
were  cases  of  sarcoma  and  295  were  cases  of  epithelioma  and  other  forms 
of  carcinoma,  including  rodent  ulcer.  The  fatality  rate  for  sarcoma 
cases  was  26.3  per  cent.,  and  in  the  remainder  of  the  group  of  malignant 
diseases,  21.4  per  cent. 

The  statistics  of  the  Johns  Hopkins  Hospital  have  been  discussed  in 
some  detail  in  another  portion  of  this  work.  At  the  present  time  these 
statistics  are  the  most  conclusive,  differentiating  the  white  and  the  colored 
patients  according  to  sex  and  specific  organs  and  parts  of  the  body 
affected  by  malignant  disease.  For  a  more  extended  discussion  the 
analysis  and  experience  data  of  this  hospital  for  the  period  1892-1911, 
published  as  a  monograph  of  the  new  series  of  Johns  Hopkins  Hospital 
Reports  No.  4  (Baltimore,  1914),  should  be  consulted. 

The  statistics  of  the  General  Memorial  Hospital  of  New  York  City 
are  subject  to  the  same  inherent  limitations  as  those  of  the  Charity 
Hospital  of  New  Orleans  and  the  American  Oncologic  Hospital  of 
Philadelphia.  It  is  also  quite  apparent  that  these  statistics  have  refer- 
ence to  lesions  observed  and  recorded  rather  than  actual  cases  and  deaths 
of  patients  under  treatment;  in  other  words,  a  patient  suffering  at  the 
time  of  death  from  several  cancerous  lesions  would  be  recorded  accord- 
ingly, and  not  only  once  as  is  essential  for  general  statistical  purposes. 
Serious  errors  are  certain  to  result  from  crude  methods  of  tabulation 
and  analysis. 

It  is  most  regrettable  that  the  statistical  aspects  of  the  cancer  problem 
should  have  been  so  superficially  considered  in  the  reports  of  special 
institutions  for  the  treatment  of  cancer  patients.  In  the  annual  reports 
of  the  Barnard  Free  Skin  and  Cancer  Hospital  of  St.  Louis,  with  others, 
no  information  whatever  is  given  regarding  results  of  treatment,  nor  are 
the  data  given  separately  according  to  sex.  The  same  conclusion  applies 
to  the  annual  reports  of  the  Free  Cancer  Hospital  of  Brompton,  London, 
which  is  even  more  important,  since  the  experience  of  this  notable  in- 
stitution extends  over  63  years. 

159 

12 


TEE  MORTALITY  FROM  CANCER 

Practical  Value  of  Uniform  Hospital  Statistics 
In  view  of  the  urgent  demand  for  trustworthy  cancer  morbidity  and 
mortahty  statistics,  it  is  self-evident  that  the  institutions  which  fail  to 
provide  the  required  amount  of  trustworthy  and  comparable  statistical 
information  fail  materially  in  the  full  discharge  of  their  duty  towards  their 
patients,  their  patrons  and  the  public  at  large.  Such  institutions  are  much 
more  likely  to  advance  their  own  interests  by  a  full  and  frank  publication 
of  the  results  than  by  the  present  methods  of  crude  and  superficial 
statistical  tabulations,  which  serve  no  practical  purpose,  but,  much  to 
the  contrary,  hinder  the  cause  of  cancer  education  and  discourage 
treatment  by  approved  methods  under  proper  institutional  conditions. 
Subjected  to  quaUfied  statistical  analysis,  the  experience  data  of 
American  general  hospitals  and  special  cancer  institutions  should  prove 
of  great  value  in  the  furtherance  of  the  scientific  study  of  the  disease. 
As  a  first  step  towards  an  urgently  required  reform,  an  understanding 
should  be  arrived  at  on  the  part  of  the  principal  institutions  to  report 
and  publish  the  facts  of  their  annual  experience  in  a  uniform  and  strictly 
comparable  manner.  Such  reports  would  in  all  probability  be  less  ex- 
pensive, and  certainly  much  more  useful,  than  the  present  methods  in 
common  use.  The  annual  reports  should  be  amplified  by  additional 
statistics  of  autopsy  records,  subjected  to  qualified  analysis,  so  as  to 
establish  with  greater  precision  the  probable  coexistence  of  cancer  and 
other  diseases.  Extreme  care,  of  course,  is  always  necessary  in  the 
interpretation  of  the  data  published  for  general  use. 

The  statistics  of  Orth  for  Berhn,  indicating  a  substantial  increase  in  the 
percentage  of  cancer  diagnoses  made  in  the  case  of  autopsies,  from  4.9 
per  cent,  in  1875,  to  7.0  per  cent.,  in  1885,  and  14.1  per  cent.,  in  1907,  do 
not,  for  illustration,  warrant  the  conclusion  that  cancer  in  Berlin  during 
this  period  has  increased  at  such  a  rate.  The  data  of  Lex  for  Heidelberg 
are  more  convincing.  Lex  shows  that  the  proportion  of  cancer  cases  in 
autopsies  increased  from  6.6  per  cent,  during  the  period  1870-79  to  9.13 
per  cent,  during  1900-07.  Reick  has  reported  the  results  for  Munich  for 
a  long  period,  showing  a  cancer  proportion  of  7  per  cent,  in  autopsies 
during  1854-63,  compared  with  12.5  per  cent,  during  1894-1903.  These 
percentages,  however,  have  reference  only  to  bodies  of  persons  ages  15 
and  over.  Steinliaus  of  Brussels  compares  more  recent  data  of  bodies  of 
persons  20  years  and  over,  showing  an  increase  from  8.6  per  cent,  during 
1888-97  to  9.1  per  cent,  during  1898-1907.  Finally,  Buday  of  Xolozvar 
reports  8.0  per  cent,  of  cancer  bodies  during  1870-88,  compared  with  9.9 
per  cent,  during  1889-1905.  These  statistics  are  quite  conflicting,  and  it 
is  doubtful  whether  they  can  be  even  approximately  considered  com- 
parable, in  view  of  the  absence  of  uniform  methods  of  anatomical 
diagnosis  and  selection  of  cases  for  post-mortem  examinations.  As 
observed  in  the  article  on  cancer  in  the  Reference  Handbook  of  the 
Medical  Sciences,  from  which  the  preceding  statistics  have  been  derived, 
the  rise  in  cancer  frequency  may  well  be  explained  by  the  fact  that 
"cancer  patients  are  much  more  apt  to  seek  treatment  in  the  hospitals 
nowadays  than  a  few  years  ago."  But  Orth  is  quoted  to  the  effect  that 
if  every  allowance  is  made  the  autopsy  statistics  show  a  moderate 
increase  in  the  incidence  of  cancer.* 

'"Reference  Handbook  of  the  Medical  Sciences,"  New  York,  1913,  Vol.  ii  (article  on  cancer). 

160 


OBSERVATIONS  AND  CONCLUSIONS 

In  the  foregoing  observations  the  main  point  of  view  has  been  the 
practical  utihty  of  cancer  hospital  statistics  to  determine  at  least  ap- 
proximately the  results  of  institutional  treatment.  It,  of  course,  is 
essential  that  the  facts  should  be  separately  stated  for  the  medical  and 
the  surgical  as  well  as  for  the  gynecological  department.  This  has  been 
done  in  the  statistics  of  the  Johns  Hopkins. Hospital,  which  it  has  been 
found  feasible  to  precisely  correlate  to  the  corresponding  population  by 
race  and  according  to  sex.  An  equally  important  purpose,  however,  is 
to  determine  with  a  close  approach  to  accuracy  the  distribution  of  cancer 
morbidity  in  sufficient  detail,  so  as  to  bring  out  the  occurrence  of  rare 
forms  of  the  disease,  as  well  as  the  preponderating  mass  of  the  more 
common  forms.  In  all  mortality  statistics  it  would  be  advisable  to 
separate  the  sarcoma  cases  from  the  carcinomata  and  to  give  the  in- 
formation by  age  and  sex,  as  has  been  done  in  an  admirable  manner  in  the 
returns  of  metropolitan  hospitals  pubhshed  for  the  year  1905  in  the 
statistical  investigations  of  cancer  by  the  Imperial  Cancer  Research 
Fund.  An  even  more  scientific  classification  was  adopted  in  the  sta- 
tistics published  in  the  second  annual  report  of  the  Harvard  Cancer  Com- 
mission differentiating  carcinoma  and  sarcoma  as  well  as  special  tumors 
and  tumor-like  conditions,  border-line  growths  and  benign  growths. 

In  detail,  there  were  treated  at  the  Colhs  P.  Huntington  Memorial 
Hospital  during  the  year  ending  June  30,  1914,  198  carcinoma  cases,  11 
sarcoma  cases,  19  special  tumors  and  tumor-hke  conditions,  14  border- 
line growths  and  8  benign  growths,  a  total  of  250  cases,  of  which  4.4 
per  cent,  were  cases  of  sarcoma.  For  reasons  which  can  not  be  dis- 
cussed at  length,  the  experience  of  every  hospital  providing  special 
treatment  for  cancer  patients  is  likely  to  be  at  variance  with  the  expe- 
rience of  other  though  similar  institutions.  The  results  of  treatment, 
also,  will  probably  never  permit  of  exact  comparison,  in  that  the  quali- 
fications or  conditions  on  admission  naturally  must  vary  widely  according 
to  the  class  of  patients  treated.  It  is  reasonable  to  suppose  that  in  pub- 
he  practice  the  proportion  of  advanced  cases  w^ll  be  much  larger  than 
in  private  practice,  and  the  same  conclusion  apphes  to  white  and  colored 
patients,  in  that  it  is  a  safe  assumption  that  the  latter  would  seek  treat- 
ment at  a  later  stage  of  the  disease  than  the  former.  _  All  of  these 
statistical  difficulties  only  tend  to  reemphasize  the  earlier  conclusion 
that  there  is  the  utmost  urgency  for  the  general  adoption  of  uniform 
methods  of  tabulation  and  analysis  on  the  part  of  at  least  the  more 
representative  institutions  for  the  treatment  of  cancer  throughout  the 
United  States.  If  this  suggestion  is  carried  into  effect,  it  is  certain 
that  the  results  will  prove  of  substantial  advantage  in  the  furtherance 
of  cancer  research. 

Cancer  Deaths  in  Public  Institutions 

The  institutional  aspects  of  the  cancer  problem  are  further  illustrated 
by  some  recent  statistics  for  England  and  Wales.  It  is  shown  that  out  of 
16,188  deaths  of  males  from  cancer,  2,640,  or  16.3  per  cent.,  occurred  in 
Poor  Law  Institutions;  157,  or  1.0  per  cent.,  in  lunatic  asylums  and 
2,015,  or  12.4  per  cent.,  in  hospitals.  Among  females,  out  of  21,135 
deaths  from  cancer,  1,928,  or  9.1  per  cent.,  occurred  in  Poor  Law  In- 
stitutions; 216,  or  1.0  per  cent.,  in  lunatic  asylums,  and  1,862,  or  8.8  per 

161 


THE  MORTALITY  FROM  CANCER 

cent.,  in  hospitals.  The  proportion  of  deaths  from  all  causes  occurring 
in  hospitals  was  8.9  per  cent,  for  males  (as  compared  with  12.4  per  cent, 
for  cancer),  and  6.9  per  cent,  for  females  (as  compared  with  8.8  per  cent, 
for  cancer).  The  proportion  of  cancer  deaths  outside  of  hospitals  was 
70.3  per  cent,  for  males  and  81.1  per  cent,  for  females.  The  statistics 
are  of  much  practical  importance,  and  it  should  not  be  difficult  to 
ascertain  the  corresponding  proportion  of  hospital  cancer  cases,  at 
least  for  the  larger  cities  of  this  country.* 

Cancer  in  Soldiers'  Homes 

The  occurrence  of  cancer  among  special  classes  warrants  much  more 
extended  statistical  consideration  than  is  usually  the  case.  There  are 
many  sources  of  useful  information  now  neglected  which  in  course  of 
time,  no  doubt,  will  be  made  use  of  to  much  practical  advantage.  Among 
others,  a  more  qualified  study  should  be  made  of  the  occurrence  of 
mahgnant  disease  among  inmates  of  our  national  homes  for  disabled 
volunteer  soldiers.  During  the  period  1906-14  there  were  300,343  veteran 
soldiers  cared  for,  among  whom  there  occurred  2,191  cases  of  malignant 
disease,  of  which  887,  or  40.5  per  cent.,  terminated  fatally  in  proportion  to 
the  number  under  observation.  The  cancer  mortality  rate  was  300  per 
100,000  exposed  to  risk.  This  apparently  very  excessive  rate  is,  of 
course,  largely,  if  not  entirely,  due  to  the  high  average  age  of  the  inmates, 
which  is  approximately  69  years.  The  experience  illustrates  the  danger 
of  using  crude  statistics  of  cancer  morbidity  or  mortality  without  a  due 
regard  to  the  age  distribution  of  the  population  considered.  It  would  be 
extremely  interesting  to  know  the  relative  frequency  of  the  different 
forms  of  cancer  among  this  rather  exceptional  class  of  persons,  but  un- 
fortunately the  medical  statistics  in  the  annual  reports  of  the  Board  of 
Managers  of  our  National  Homes  for  Disabled  Volunteer  Soldiers  do 
not  furnish  the  required  details. 

Surgical  Aspects 

A  critical  discussion  of  the  medical  and  surgical  aspects  of  the  cancer 
problem  lies  outside  the  scope  and  plan  of  this  work.  The  statistical 
analysis  of  surgical  experience,  whether  institutional  or  private,  is  beset 
with  many  difficulties  which  have  their  origin  in  the  nature  of  the  case, 
that  the  condition  of  the  patients  on  admission  must  necessarily  vary 
widely,  while  at  the  same  time  fundamentally  conditioning  the  results 
of  operative  treatment  and  the  duration  of  the  future  lifetime  of  surviv- 
ing cases.  A  collective  investigation  would  unquestionably  produce 
much  interesting  information  and  meet  some  of  the  difficulties  which 
arise  out  of  the  paucity  of  the  data  derived  from  small  institutional  or 
limited  private  clinical  experience.  It  is  remarkable  that  the  statistics 
of  large  hospitals,  which  might  yield  much  useful  information,  have  with 
few  exceptions  not  been  presented  in  a  useful  form  in  the  annual  reports 
of  even  large  and  influential  public  institutions.  An  extended  analysis 
of  the  data  of  the  Johns  Hopkins  Hospital,  Baltimore,  sustains  the  con- 
clusion that  the  immediate  results  of  operative  treatment  are  quite 
favorable  in  the  majority  of  cases,  as  shown  by  the  table  following, 
derived  from  "The  Menace  of  Cancer,"  in  the  Transactions  of  the 
American  Gynecological  Society,  for  1913. 

*Annual  Reports  of  the  Registrar-General  for  England  and  Wales  for  1912  and  1914.  See  also  note  to 
Table  2,  Appendix  B. 

162 


OBSERVATIONS  AND  CONCLUSIONS 

Cancer  Statistics  of  Johns  Hopkins  Hospital,  Surgical  Department  Cases 

by  Sex,  1902-1911 


WHITE  PATIENTS 

Males 

Females 

Cases 

Deaths 

Per  Cent. 

Cases 

Deaths 

Per  Cent 

Buccal  cavity 130 

15 

11.5 

13 

1 

7.7 

Stomach  and  liver 110 

26 

23.6 

56 

13 

23.2 

Peritoneum,  intestines,  rectum.     88 

19 

21.6 

35 

9 

25.7 

Female  generative  organs 

3 

2 

66.7 

Breast 

251 

14 

5.6 

Skin 40 

4 

10.0 

10 

Other  or  not  speciJfied  organs .  .  .  435 

57 

13.1 

117 

7 

6.0 

All  organs 803 

121 

15.1 

485 

46 

9.5 

According  to  this  table  the  fatality  rate  was  15.1  per  cent,  for  males  and 
only  9.5  per  cent,  for  females,  but  this,  of  course,  is  exclusive  of  the  ex- 
perience with  gynecological  cases,  which  are  separately  given  in  the 
table  following: 

Cancer  Statistics  of  Johns  Hopkins  Hospital,  Gynecological 
Department  Cases,  1902-1911 

WHITE  PATIENTS 

Cases  Deaths  Per  Cent. 

Stomach  and  liver 8  3  37.5 

Peritoneum,  intestines,  rectum.  .      23  2  8.7 

Generative  organs 331  35  10.6 

Breast 2 

Skin 

Other  or  not  specified  organs ....     39  5  12.8 

All  organs 403  45  11 .2 

The  foregoing  tables  are  restricted  to  the  white  patients,  since  the  data 
for  colored  patients  are  rather  limited,  with  the  exception  of  cancer  of  the 
generative  organs.     The  facts  are  briefly  given  in  the  table  below : 

Cancer  Statistics  of  Johns  Hopkins  Hospital,  Gynecological 
Department  Cases,  1902-1911 

COLORED  PATIENTS 

Cases  Deaths  Per  Cent. 

Stomach  and  liver 1 

Peritoneum,  intestines,  rectum.  .       6  1  16.7 

Generative  organs 78  9  11.5 

Breast 1 

Skin 

Other  or  not  specified  organs ....     16  2  12.5 

All  organs 102  12  11.8 

163 


THE  MORTALITY  FROM  CANCER 

Postoperative  Results 

There  have  been  few  quahfied  investigations  as  regards  postoperative 
results.  The  published  statistics  are,  as  a  rule,  too  limited  in  the  number 
of  cases  available  and  too  indefinite  as  regards  the  tracing  of  all  of  the 
patients  for  the  required  length  of  time  after  the  date  of  the  operation. 
A  considerable  amount  of  interesting  information  on  this  phase  of  the 
cancer  problem  has  been  brought  together  by  Charles  P.  Childe,  in  his 
treatise  on  "The  Control  of  a  Scourge,"  published  in  1906.  As  a  first 
step  in  the  direction  of  systematically  observing  the  results  of  institu- 
tional treatment,  the  Massachusetts  General  Hospital  has  adopted  a 
follow-up  system  which  in  course  of  time  should  yield  results  of  great 
practical  value.  As  an  illustration  of  the  results  obtained  by  means  of 
qualified  surgical  treatment,  the  following  observations  by  Dr.  E.  S. 
Judd  of  Rochester,  Minn.,  based  upon  his  experience  in  the  Mayo  clinic, 
are  here  included: 

Of  the  514  patients  of  whom  the  subsequent  history  is  known,  266,  or  52  per  cent.,  are 
known  to  be  dead,  though  21  of  these  died  from  other  causes  without  cHnical  signs  of 
recurrence  of  carcinoma,  leaving  a  balance  of  48  per  cent,  of  deaths,  probably  from  cancer, 
for  the  entire  series.  Two  hundred  and  forty -eight  of  the  514  patients  were  known  to  be 
alive  from  2  to  11%2  years;  37  of  these  were  known  to  have  recurrences.  Of  the  patients 
operated  on  during  the  years  1902  and  1903,  40  have  been  traced,  27  were  known  to  be  dead 
from  various  causes,  leaving  a  percentage^  33  ahve  without  recurrence  for  more  thati  ten 
years.  Three  of  those  who  died  lived  more  than  6  years  and  died  from  other  causes.  Of 
the  321  patients  operated  on  more  than  5  years,  266  were  traced;  148  were  known  to  be 
dead  and  106  living,  a  percentage  of  40  who  had  lived  more  than  5  years.  Six  of  the  living 
had  recurrences.  Fourteen  of  these  dead  had  died  from  other  causes  than  cancer.  Of  the 
510  patients  operated  on  more  than  three  years,  437  had  been  traced;  234  were  dead,  191 
living,  a  percentage  of  45  patients  living  more  than  3  years.  Twenty-seven  of  these  had 
recurrences.  Nineteen  of  those  dead  had  died  from  other  causes.  One  case  was  reported 
of  a  patient  who  died  91/2  years  after  the  primary  operation  from  general  carcinosis; 
one  from  internal  metastases  without  local  recurrence'6%2  years  after  operation;  and  one 
on  whom  a  secondary  operation  for  recurrence  was  done  12  years  after  the  primary 
operation.  In  this  latter  case  the  patient  remained  well  nearly  three  years  after  the 
secondary  operation.* 

Problem  of  Recurrence 

The  surgical  aspects  of  the  cancer  problem  suggest  a  brief  reference  to 
the  related  factor  of  recurrence,  by  which  is  meant  "the  reappearance  of 
malignant  disease  in  the  locality  occupied  by  the  primary  tumor,  in  the 
immediate  neighborhood,  in  the  regional  lymph  nodes,  or  in  the  distant 
parts  of  the  body,  after  operative  or  other  interference  that  has  ap- 
parently insured  the  destruction  of  the  disease."  As  observed  in  the 
article  on  cancer  in  the  Reference  Handbook  of  the  Medical  Sciences,! 
"Recurrence  in  the  lymph  nodes  or  in  the  distant  organs  must  be 
explained  by  the  assumption  that  dissemination  of  the  disease  has  taken 
place  even  before  the  operation.  Examples  of  very  late  recurrences  many 
years  after  the  operation  have  forced  the  assumption  of  a  possible 
latency  of  cancer  cells;  thus,  a  pigmented  cancer  of  the  liver  appearing 
many  years  after  the  extirpation  of  the  primary  disease  affecting  one  eye 
is  best  explained  by  such  a  hypothesis.  Late  local  recurrence,  on  the 
other  hand,  may  be  interpreted  as  a  result  of  continuation  of  the  same 
conditions  as  have  led  to  the  appearance  of  the  primary  malignant 

*Medical  Record,  February  21, 1914. 

f'Reference  Handbook  of  the  Medical  Sciences,"  New  York,  1913,  Vol.  ii,  p.  601. 

164 


OBSERVATIONS  AND  CONCLUSIONS 

disease. "  In  the  article  referred  to,  W.  R.  Williams  is  quoted  to  the  effect 
that  sixty-four  per  cent,  of  all  mammary  cancer  recurrences  take  place 
within  the  first  six  months  after  operation,  and  about  two-thirds  of  these 
appear  within  the  first  three  months.  The  new  cancer  centers  may  be 
followed  by  second  or  even  third  recurrences  after  operative  removal; 
occasionally  even  more  numerous  recurrences  have  been  observed, 
though  usually  the  disease  is  either  destroyed  by  the  repeated  operations 
or  the  patient  succumbs  to  involvement  of  distant  parts  of  the  body. 

On  the  question  of  recurrence  much  has  been  written  to  small  purpose. 
The  statistical  determination  of  the  results  involves  serious  practical 
difiiculties,  which  are  quite  similar  to  those  met  wdth  in  investigations 
of  post-discharge  results  in  the  sanatoria  treatment  of  tuberculosis. 

Duration  of  Disease 

The  probfem  of  recurrence  is  closely  allied  to  the  question  of  disease 
duration,  which  particularly  in  cancer  has  not  been  determined  with 
accuracy,  even  in  regard  to  the  period  intervening  between  the  appear- 
ance of  the  first  serious  symptoms  demanding  medical  treatment  and 
the  fatal  termination  of  the  case.  The  statistics  of  the  New  York 
State  Institute  for  the  Study  of  Malignant  Disease,  elsewhere  discussed, 
throw  some  light  on  this  phase  of  the  cancer  problem,  but  the  data 
require  to  be  used  wath  extreme  caution.  As  observed  by  Rudolph 
Schmidt  in  his  treatise  on'  the  "Diagnosis  of  the  Malignant  Tumors 
of  the  Abdominal  Viscera,"  the  duration  of  the  disease  manifestations 
from  their  first  appearance  to  their  ending  by  death  naturally  varies 
within  wide  limits.  In  only  a  single  instance  of  his  case  histories  was 
there  a  probability  of  three  years'  duration,  but  not  infrequently  cases 
were  found  to  extend  over  two  years  and  several  months,  so  that  cases 
running  over  a  period  of  two  years  could  not  be  considered  rare,  and  the 
facts  available  would  seem  to  prove  that  a  correct  diagnosis  could  have 
been  made  at  the  beginning-  of  the  disease.  Dr.  Otto  of  Copenhagen, 
at  the  second  International  Conference  on  Cancer,  held  in  Paris  in 
1910,  gave  an  interesting  account  of  the  duration  of  malignant  disease 
of  the  digestive  tract,  demonstrating  the  shortness  of  the  period  betw^een 
the  first  symptoms  and  death  in  196  cases,  and  concluding  that  "the 
first  symptoms  appeared  and  the  clinical  diagnoses  were  made  subse- 
quent to  a  long  latent  period,  of  which  the  duration  depended  upon 
•anatomical  and  other  factors."*- 

The  Pennsylvania  Cancer  Commission,  in  an  investigation  of  400 
cases,  according  to  Dr.  John  A.  Hartwell,  found  that 

Superficial  cancer  had  been  apparent  on  an  average  of  eighteen  months  before  the  case 
came  to  the  surgeon,  and  eleven  months  had  elapsed  between  the  time  that  a  surgeon  had 
been  consulted  and  the  date  of  the  operation.  In  deep  cancers  this  time  was  one  year. 
About  one  case  in  thirty  of  breast  cancer  was  not  even  examined  by  the  first  physician 
consulted,  and  in  one  case  in  six,  salves,  ointments,  etc.,  were  prescribed,  with  ad^^ce  to 
temporize.  Sixty-eight  per  cent,  only  of  superficial  cancers  were  operable  when  they  came 
to  the  surgeon.  Only  48  per  cent,  of  deep-seated  cancers  were  operable  when  first  seen  by 
the  surgeon.  In  a  'series  of  cases  covering  five  years  in  a  representative  hospital  over  63 
per  cent,  of  the  cancer  cases  were  foimd  totally  inoperable.f 

*British  Medical  Journal;  October  22, 1910. 

iiledical  Record,  New  York,  April  26,  1913.  See  also  report  to  Medical  Society  of  Pennsylvania  by  its 
Commission  on  Cancer,  by  J.  M.  Wainwright,  Chairman,  Harrisburg,  Pa. 

165 


TEE  MORTALITY  FROM  CANCER 

In  this  connection  the  following  table,  derived  from  the  special  report 
on  cancer  in  Ireland,  showing  the  duration  of  previous  illness  accord- 
ing to  sex,  for  all  cancers,  and  separately  for  cancer  of  the  stomach, 
uterus  and  breast,  is  included  as  an  interesting  illustration  of  the  utility 
of  even  crude  statistical  methods  in  rendering  aid  to  the  cause  of  cancer 
research. 

Mortality  from  Cancer  in  Ireland,  by  Organs  and  Parts,  and  Duration  of 
Illness,  according  to  Sex,  1901 


Males 

Duration  of                      All  Organs  Stomach 

Illness                         (Per  Cent.)  (Per  Cent.) 

Under  6  months 34.0  41.6 

6  months-1  year 37.0  36.7 

1-2  years 21.1  19.6 

2-3  years 4.2  1.2 

Over  3  years 3.7  0.9 

Total  with  known         

duration 100.0  100.0 


Females 


All  Organs 
(Per  Cent.) 

30.7 

35.5 

24.1 

5.5 


Stomach 
(Per  Cent.) 

39.0 

34.6 

21.3 

3.5 

1.6 


Uterus 
(Per  Cent.) 

20.3 

46.5 

26.2 

3.8 

3.2 


Breast 
(Per  Cent.) 

11.2 
32.5 
37.7 
10.8 
7.8 


100.0 


100.0 


100.0 


100.0 


(For  details  see  Tables  47  and  48  of  Appendix  G.) 


It  is  brought  out  by  this  interesting  analysis  that  the  proportion  of 
cancer  deaths  with  a  previous  disease  history  of  over  3  years  was  3.7 
per  cent,  for  males,  and  4.2  per  cent,  for  females,  of  the  cases  with  a 
known  duration.  For  cancer  of  the  stomach  the  corresponding  pro- 
portion was  0.9  per  cent,  for  males,  and  1.6  per  cent,  for  females;  for 
cancer  of  the  uterus,  3.2  per  cent.;  and  for  cancer  of  the  breast,  7.8  per 
cent.  In  the  majority  of  cases  of  known  duration  the  disease  had  been 
in  existence  or  had  been  observed  by  the  patient  for  at  least  six  months 
or  over.*  For  cases  of  known  duration  the  proportion  of  cancer  deaths 
with  a  previous  history  of  over  1  to  2  years  was  21.1  per  cent,  for  males, 
and  24.1  per  cent,  for  females.  Accepting  the  principle  laid  down 
by  the  American  Society  for  the  Control  of  Cancer,  that  "in  the  early 
recognition  and  treatment  of  the  disease  lies  the  hope  of  a  cure,"  it  is 
self-evident  that  a  fatal  termination  could  in  many  cases  be  prevented 
by  the  avoidance  of  needless  and  hopeless  delay,  f 

Degree  of  Malignancy 

The  previous  duration  of  cancerous  disease  is  primarily  conditioned 
by  the  type  of  the  cancerous  growth,  which  is  subject  to  a  varying  degree 
of  malignancy,  in  turn  affected  by  the  powers  of  disease  resistance, 
which  are  also  subject  to  wide  variations.  There  are,  for  illustration, 
the  slow  growing  tumors,  arising  from  fibroblasts,  called  fibromata,  and 
the  rapidly  growing  fibrosarcomata,  which,  according  to  F.  B.  Mallory, 
"represent  extremes  in  the  rate  of  growth."     The  duration  of  the  disease 

*Some  interesting  facts  are  disclosed  by  the  analysis  of  the  Ordinary  Ejrperience  of  The  Prudential  Insur- 
ance Company  of  America  for  the  period  1886-1912  (1401  male  deaths,  and  641  female  deaths).  For  males  the 
average  previous  duration  of  insurance  was  6.8  years  for  cancer  of  the  stomach  and  liver,  6.5  years  for  cancer  of 
the  peritoneum,  intestines  and  rectum,  6.3  years  for  cancer  of  other  organs  or  parts,  5.7  years  for  cancer  of  the  skin, 
and  5.6  years  for  cancer  of  the  buccal  cavity.  For  females  the  average  previous  duration  of  insurance  for 
cancer  of  the  stomach  and  liver  was  6.3  years,  for  cancer  of  the  breast,  6.3  years;  for  cancer  of  other  organs  or 
parts,  5.7  years;  for  cancer  of  the  skin,  5.6  years;  for  cancer  of  the  peritoneum,  intestines  and  rectum,  6.4  years; 
and  for  cancer  of  the  generative  organs,  5.2  years. 

tSome  additional  data  on  the  subject  of  duration  of  cancer  previous  to  death  are  given  on  page  115. 


166 


OBSERVATIONS  AND  CONCLUSIONS 

requires,  therefore,  to  be  determined  with  reference  to  biological  con- 
siderations, and  especially  is  this  true  in  regard  to  the  primary  division  of 
cancers  into  sarcomata  and  carcinomata.  The  former,  which  are  much 
more  common  in  early  life,  usually  run  a  much  more  rapid  course, 
whereas  in  some  of  the  latter,  particularly  in  very  advanced  ages,  the 
duration  of  the  disease  may  extend  over  a  number  of  years.  The  statisti- 
cal aspects  of  this  phase  of  the  cancer  problem  have  as  yet  received  very 
inadequate  consideration.  It  has  been  observed  in  this  connection  by 
Dr.  C.  Mansell  Moullin,  that 

Cancer  is  not  a  definite  entity  nor  is  sarcoma.  The  cancer  of  one  organ  differs  from  the 
cancer  of  every  other  organ,  and  the  cancer  of  each  individual  person  is  as  different  from  the 
cancer  of  all  other  individuals  as  his  constitution  is  from  theirs.  .  .  .  Sarcoma  and 
carcinoma  are  artificial  groups,  not  natural  ones.  It  is  not  possible  to  define  or  limit 
either  of  them.*  .  .  .  The  cancer  of  one  organ  is  entirely  different  from  the  cancer  of 
every  other  organ,  and  the  clinical  history  of  periosteal  sarcoma  varies  with  the  bone  to 
which  the  periostemn  belongs.  Each  organ  and  each  tissue  has  its  own  variety  of  malig- 
nant tumor,  just  as  it  has  its  own  variety  of  innocent  tumor,  though  the  microscope  may  be 
unable  to  distinguish  them,  and  the  innocent  tumors  of  each  organ  shade  off  by  imper- 
ceptible stages  into  the  malignant  ones,  so  that  together  they  form  one  group.  No  line 
can  be  drawn  between  them.f 

These  observations  reemphasize  the  earlier  conclusions  regarding  the 
difficulties  of  a  generally  satisfactory  tumor  classification.  If  the  point  of 
view  advanced  by  Dr.  Moullin  is  sound,  that  "clinical  characteristics  are 
of  no  value  for  the  classification  of  pathological  growths  such  as  tumors," 
and  "whether  a  tumor  is  what  we  call  malignant  or  not  depends  upon  the 
degree  of  maturity  already  reached  by  the  cell  from  which  the  tumor  bud 
first  branched  off  upon  its  independent  career,"  there  remains  probably 
no  other  course  in  statistical  procedure  than  to  continue  the  present 
practice  of  an  anatomical  classification,  which  simply  by  reference  to  the 
organ  or  part  of  the  body  affected  by  malignant  disease  indicates  with  a 
high  degree  of  accuracy  the  immediately  important  contributory  circum- 
stance or  condition  responsible  for  the  primary  cancerous  growth. 

The  involved  nature  of  the  tumor  problem  presents  so  many  interest- 
ing and  important  special  problems  that  it  would  be  utterly  hopeless 
to  meet  the  requirements  of  biological  or  pathological  science  by  even  the 
most  refined  methods  of  statistical  analysis.  For  illustration,  tumors 
have  various  shapes,  or  according  to  the  division  adopted  by  Delafield 
and  Prudden,  they  may  be  nodular,  tuberous,  fungoid,  polypoid, 
papillary,  dendritic,  lobulated,  etc.  They  may  occur  singly  or  in 
greater  or  less  numbers  in  the  same  or  in  different  parts  of  the  body. 
The  degree  of  malignancy  could  probably  never  be  successfully  pre- 
sented by  means  of  statistical  data,  even  though  derived  from  a  large 
institutional  experience.  According  to  Delafield  and  Prudden,  "The 
more  obvious  marks  of  malignancy  in  a  tumor  are:     1.  Invasion  of 

*The  Lancet,  March  21, 1914. 

t  RELATIVE  INCIDENCE  OF  CARCINOMA  AND  SARCOMA 

Total  Deaths  Deaths  from  Per 

from  Cancer  Sarcoma  Cent. 

England  and  Wales  ,_908-1912) 174,602  10,250  5.87 

Scotland  (1907-1911) 23,755  1,245  5.24 

Ireland  (1908-1912) 17,796  812  4.56 

Norway  (1908-1912) 11,461  580  5.06 

Switzerland  (1906-1910) 22,963  1,368  5.96 

167 


THE  MORTALITY  FROM  CANCER 

adjacent  tissues  by  eccentric  or  peripheral  growth.  2.  The  tendency 
to  local  recurrence  after  removal.  3.  The  formation  of  metastases. 
4.  An  interference  with  the  nutrition  and  general  well-being  of  the 
body,  which  may  give  rise  to  a  condition  known  as  cachexia."  Here  also 
the  methods  of  statistical  analysis  must  prove  inadequate  to  the  needs 
of  the  medical  and  surgical  profession. 

Rapidity  of  Growth 
However  involved  these  biological  and  pathological  considerations  of 
the  cancer  problem  may  be  to  the  statistician,  they  can  not  be  entirely 
ignored ;  in  fact,  to  a  large  extent  the  correct  interpretation  of  statistical 
data  depends  upon  a  thorough  understanding  of  the  underlying  ele- 
ments of  the  problem,  which,  if  left  out  of  consideration,  may  seriously, 
if  not  completely,  invalidate  the  conclusions  reached.  In  regard  to  the 
average  duration  of  cancerous  disease  and  the  relative  rapidity  of  growth 
of  tumor  tissue,  it  may  not  be  inappropriate  to  include  here  the  following 
interesting  observation  by  Ritchie : 

Rapidity  of  Growth. — This  varies  very  much  in  different  cases.  Sometimes,  as  in  the 
case  of  many  malignant  connective-tissue  tumors — e.  g.,  those  occurring  in  bone — the 
growth  is  extremely  rapid,  and  in  the  course  of  a  few  months,  or  it  may  be  weeks,  the  tumor 
may  attain  to  such  a  size  as  to  constitute  a  very  definite  proportion  of  the  total  body  weight. 
In  such  a  case,  direct  microscopic  evidence  of  vegetative  activity  may  be  found  in  the 
abundance  of  mitotic  figures  observable  in  the  cells.  In  other  cases  of  malignant-tumor 
formation  the  growth  is  much  more  slow,  this  being  exemplified  in  certain  epithelial  tvunors, 
say  of  the  lip,  and  especially  in  some  of  the  tumors  liable  to  develop  in  connection  with  the 
intestinal  mucous  membrane.  Here  there!  may  be  evidence  of  tumor  formation  being 
present  for  many  months,  in  certain  cases  years,  before  any  gross  tumor  results.  Generally 
speaking,  the  connective-tissue  tumors  are  those  of  most  rapid  growth,  and  the  epithelial 
and  hypoblastic  tumors  are  the  slowest. 

To  the  foregoing  is  added  the  following  extremely  interesting  observa- 
tions by  Hastings  Gilford,  from  his  treatise  on  "The  Disorders  of  Post- 
Natal  Growth  and  Development": 

Cancer  varies  greatly  in  its  rate  of  extension.  It  may  be  so  rapid  as  to  simulate  in- 
flammation. Indeed,  quickly  growing  sarcomata  accompanied  by  redness  and  pain  have 
often  been  opened  in  mistake  for  abscesses.  On  the  other  hand,  cancers  are  sometimes 
so  slow  in  their  progress  that  they  make  very  little  headway,  even  after  they  have  been  in 
existence  for  years,  and  are  prone  to  be  mistaken  for  fibromata.  Their  rate  of  growth  is 
largely  influenced  by  the  surroundings.  If  adjacent  cells  be  also  more  or  less  on  the  verge 
of  degeneration,  as  in  old  age,  the  progress  is,  as  a  rule,  very  slow.  If,  on  the  other  hand, 
the  neighboring  cells  are  engaged  in  the  activity  associated  with  progressive  development, 
then  the  progress  of  the  cancer  is,  as  a  rule,  greatly  accelerated.  The  difi^erence  seems  to 
depend  upon  the  suitability  of  the  environment.  When  the  surroundings  are  congenial 
the  progress  is  slow;  when  they  are  uncongenial  the  progress  is  rapid.  It  is,  perhaps,  never 
more  rapid  than  when  the  cancer  attacks  the  lactating  breast,  and  never  slower  than  when 
it  forms  in  the  useless  senile  breast,  as  the  "stone  cancer"  of  old  women.  All  forms  of  cancer 
are  more  prone  to  appear  in  those  organs  which  naturally  undergo  rapid  changes,  like  the 
breast,  and  the  glands  in  the  cervix  of  the  uterus,  than  in  those  which  are  comparatively 
stable  in  their  development,  like  bone,  cartilage,  and  muscle.  Cancers  show  at  times  the 
peculiar  feature  of  being  temporarily  delayed  or  stopped  in  their  progress,  and  these 
phases  of  arrest  or  of  increase  may  alternate  more  than  once  before  the  diseasa  finally  puts 
an  end  to  existence. 

These  observations  are  of  much  practical  importance  in  connection 
with  well-directed  efforts  to  arouse  public  interest  in  the  menace  of 
cancer  and  the  possibilities  of  cancer  control. 

The  problem  of  fundamental  causation  must  for  the  time  being  be 
considered  secondary  in  importance  to  the  question  of  conditioning  or 

168 


OBSERVATIONS  AND  CONCLUSIONS 

contributory  circumstances  favorable  to  the  occurrence  and  develop- 
ment of  malignant  disease:  for  if  even  so  simple  a  fact  can  be  brought 
home  to  the  laity  that  there  is  a  material  difference  in  the  rate  of  malig- 
nant growth— whether  sarcomata  or  carcinomata,  whether  among  the 
young  or  among  the  old,  whether  among  the  strong  and  robust  or  among 
the  anaemic  and  weak — much  will  have  been  gained  in  the  direction 
of  increasing  the  number  of  cases  presenting  themselves  for  early  and 
qualified  operative  or  other  treatment.  The  public  must  understand 
that  there  are  degrees  of  malignancy  and  that  there  is  an  increased 
probability  of  recurrence  in  the  case  of  delayed  operation.  As  a  rule, 
"the  less  difiFerentiated  the  type  of  cell  composing  the  tumor  the  more 
malignant  it  is,"  and  "the  small  round-celled  sarcoma  is  one  of  the  most 
malignant  types."  Since  the  sarcomata  are  much  more  common  to 
children  and  young  persons,  it  is  self-evident  that  the  earliest  possible 
qualified  treatment  is  imperatively  called  for  in  such  cases  where  the 
preliminary  diagnosis  warrants  even  the  suspicion  of  a  possibly  malignant 
growth.  "Experience,"  according  to  Montgomery,  "has  taught  us  to 
give  a  very  unfavorable  prognosis  when  cancer  of  the  uterus  appears 
prior  to  the  age  of  40.  Possibly  the  hopeless  outlook  is  in  part  due  to 
the  greater  activity  of  the  lymphatic  system,  the  vessels  of  which  de- 
crease in  size  and  number  with  the  advent  of  climacteric."* 

The  age  of  the  patient  in  cancer  cases  is  always  an  element  of  im- 
portance in  estimating  the  probabilities  of  successful  treatment.  Lock- 
wood  in  his  treatise  on  "Cancer  of  the  Breast,"  concludes  that  "a  breast 
tumor  in  a  young  woman  is  more  likely  to  be  innocent  than  malignant." 
The  average  age  of  43  women  operated  upon  for  innocent  tumors  was 
only  36.6  years,  whereas  the  average  age  of  47  persons  operated  upon  for 
carcinoma  of  the  breast  was  53.68  years. 

Clinical  Signs 

There  are  apparently  no  absolutely  conclusive  clinical  signs  which 
can  be  relied  upon  for  the  correct  diagnosis  of  tumors;  but  malignant 
disease,  at  least  when  fairly  well  advanced,  is,  as  a  rule,  a  cause  of 
emaciation.  Under  the  title  of  "General  Debility,  Pallor,  Emaciation," 
Savill  enumerates  the  symptoms  of  malignant  disease  to  consist  of  (1) 
a  loss  of  weight,  which  occurs  quite  early  in  the  disease,  sometimes  long 
before  any  local  signs  can  be  detected.  This  is  accompanied  by  a  typical 
cachexia — i.  e.,  an  appearance  of  illness  in  which  the  skin  assumes  an 
ashy  or  sallow  hue.  (2)  The  age  of  the  patient  is  generally  advanced  in 
carcinoma,  young  in  sarcoma,  and  the  four  classical  signs  of  the  disease 
are  pain,  swelling,  offensive  discharge  and  haemorrhage.  (3)  Pain  at 
the  seat  of  growth  is  often  complained  of,  especially  in  rapidly  growing 
varieties,  or  when  they  occur  in  tense  parts.  (4)  In  accessible  situations 
a  thickening,  swelling,  or  tumor  may  be  detected,  which  is  usually  hard, 
nodular,  and  apt  to  fix  and  infiltrate  the  surrounding  parts.  Some 
sarcomata,  however,  are  soft  and  pulsating.  (5)  Whenever  the  growth 
involves  a  mucous  or  epidermal  surface  there  is  an  offensive  pink  or 
sero-sanguineous  discharge.  (6)  In  like  manner  haemorrhage  may 
occur,  and  take  the  form  either  of  metrorrhagia,  coffee-ground  vomiting, 

*Joumal  of  the  American  Medical  Association,  September  21,  1907. 

169 


TEE  MORTALITY  FROM  CANCER 

or  melsena;  and  when  tlie  disease  involves  the  pleura  or  peritoneum  the 
effused  fluid  will  be  blood-stained.  (7)  In  carcinoma  the  neighboring 
lymphatic  glands  become  enlarged  and  palpable.  (8)  The  rate  of 
growth  is  rapid,  though  it  varies  widely  in  different  forms  and  localities. 
Scirrhous  infiltration  of  orifices  may  only  reach  the  thickness  of  half  an 
inch  in  six  to  twelve  months,  and  the  patient  may  live  two  years ;  but  a 
round-celled  sarcoma  may  reach  the  size  of  a  hen's  egg  in  a  month  or  two 
and  kill  in  six.* 

Anaexnia  and  Emaciation 

To  much  the  same  effect  is  the  enumeration  of  symptoms  by  William- 
son in  the  fourth  edition  of  French's  "Practice  of  Medicine."  With 
special  reference  to  cancer  of  the  stomach,  it  is  held  that 

There  is  great  diversity  in  the  symptoms  of  different  cases.  There  may  be  no  manifesta- 
ions  by  which  the  disease  can  be  recognized  untU  comparatively  late.  The  history  of  it 
that  is  generally  obtained  is  indigestion  during  several  months,  increasing  in  severity,  and 
attended  ■nnth  anemia  and  emaciation.  ,  .  .  The  early  symptoms  in  an  ordinary  case 
are  loss  of  appetite,  impaired  digestion,  pain,  nausea,  and  vomiting,  f  These  usually 
develop  so  insidiously  as  to  conceal  the  time  of  actual  onset;  rarely,  however,  they  appear 
abruptly  after  an  attack  of  influenza,  or  an  acute  indigestion.  .  .  .  Pain  is  a  promi- 
nent sjTnptom  in  about  three-fourths  of  the  cases  and  often  occurs  early.  It  is  usually 
confined  to  the  epigastrium,  but  may  be  referred  to  the  shoulders,  sides  or  back.  It  is 
generally  of  a  burning,  gnawing,  or  dragging  character;  distinct  cardialgia  rarely  occurs. 
It  is  generally  constant,  but  increased  by  ingestion  of  food.  .  .  .  Anemia  and , 
cachexia  are  often  early  symptoms  and  almost  invariably  present.  The  number  of  red 
corpuscles  often  sinks  below  3,000,000,  occasionally  below  2,000,000,  and  the  hemoglobin 
may  fall  below  50  per  cent.  .  .  .  ^Tien  the  anemia  is  extreme  there  is  often  edema  of 
the  lower  extremities  and  sometimes  a  more  general  dropsy.  Emaciation  often  begins 
early,  but  in  a  large  proportion  of  cases  there  is  httle  loss  of  weight  until  a  late  period  of  the 
disease.  The  degree  of  emaciation  is  often  remarkable,  the  body  being  literally  reduced  to 
"skin  and  bones."  The  decline  of  strength  usually  keeps  pace  'nith  the  loss  of  flesh,  but  a 
surprising  degree  of  \-igor  is  sometimes  retained  to  the  end.  J 

These  extended  references  to  the  diagnosis  of  cancer  are  included  pri- 
marily for  the  purpose  of  emphasizing  the  diflBculties  of  the  statistical 
treatment  of  the  more  complex  aspects  of  the  cancer  problem.  They 
also  have  reference  to  the  question  of  accuracy  and  completeness  in  death 
certification;  but  it  is  necessary  to  keep  in  mind  that  the  initial  diagnosis 
is  naturally  much  more  diflScult  than  the  terminal  diagnosis,  when,  at 
least  to  the  trained  physician,  the  manifestations  of  the  disease  are 
readily  apparent. 

Prognosis  of  Cancer 

The  prognosis  of  cancer,  particularly  in  cases  where  the  treatment 
has  been  delayed,  is,  according  to  Savill,  "always  of  the  gravest  kind, 
the  course  rarely  lasting  more  than  one,  or  at  the  outside,  two  years. 
.  .  .  The  prognosis  largely  depends  upon  the  stage  at  which  the  true 
nature  of  the  case  is  detected.     On  this  depends  very  largely  both  the 

•Sa^Tll,  "System  of  Clinical  Medicine,"  New  York,  1912,  3d  edit.,  p.  588. 

f'Cancers  vary  much.  Some,  for  instance  those  of  the  skin  or  lip,  cause  no  anamia,  while  a  fulminating 
cancer,  as  of  the  stomach,  may  give  a  perfect  picture  of  preliminary  pernicious  anemia,  or,  indeed,  of  leuksemia. 
In  general  it  is  stated  that  the  more  malignant  the  tumor  the  greater  the  blood  changes,  and  the  more  extensive 
the  cancer,  that  is,  the  more  its  metastases,  the  greater  its  influence  upon  the  blood.  But  this  is  not  entirely 
true:  our  cases  with  rapidly  developing  metastases,  with  large  nodules,  are  those  with  a  slight  chlorotic  ansemia; 
those  which  simulate  pernicious  ansemia  are  more  often  cases  with  few  if  any  objective  signs  of  cancer,  and  at 
autopsy  one  finds  an  insignificant  looking  little  nodule."     (Emerson's  "Clinical  Diagnosis,"  p.  636.) 

JFrench,  "Practice  of  Mediciae,"  4th  edit.,  pp.  773-776. 

170 


OBSERVATIONS  AND  CONCLUSIONS 

prospect  of  arrest  and  of  removal.  In  general  terms  the  prognosis  also 
depends  on  (1)  the  position  and  accessibility  of  the  growth,  how  far 
vital  structures  are  involved,  and  whether  it  is  on  or  near  the  surface; 
(2)  the  structure  of  the  tumor;  and  (3)  the  age  of  the  patient,  to  some 
extent,  for  growth  is  more  rapid  in  the  young."* 

These  observations  have  an  important  bearing  upon  the  problem  of 
cancer  control.  At  the  present  time  the  percentage  of  cases  suc- 
cessfully treated  is  relatively  small,  as  made  evident  by  the  con- 
siderable annual  mortality  from  malignant  disease  throughout  the 
civilized  world.  The  available  evidence  is  entirely  conclusive  that  by 
early  diagnosis  and  prompt,  radical  treatment,  a  fair  proportion  of  the 
lives  now  lost  could  be  saved  or  prolonged  for  many  years.  As  pointed 
out  by  Bloodgood,  "The  clinical  symptoms  of  cancer  of  the  uterus  are 
so  distinct  that  it  should  not  be  difficult  to  educate  patients  and  the 
profession,  but  unfortunately,  even  at  present,  the  percentage  of  patients 
with  cancer  of  the  uterus  seeking  expert  surgical  advice  in  the  inoperable 
group  is  still  large,"  and  he  points  out  further  in  this  connection  that  "if  it 
has  been  difficult  to  educate  people  and  the  profession  as  to  the  potential 
danger  of  a  lump  in  the  breast,  small  and  painless  defects  of  the  skin 
and  mucous  membranes  and  irregular  bleeding  from  the  uterus,  it  will 
be  much  more  difficult  to  educate  them  to  the  significance  of  abdominal 
pain,  indigestion  and  changes  in  the  stools."  He  therefore  concludes 
that  the  control  of  cancer  is  a  problem  of  education,  and  that  those 
clinics  which  have  the  records,  the  pathological  proofs,  must  work  up 
their  statistics  so  that  we  may  increase  our  evidence  in  support  of  the 
statement  that  cancer  has  been  cured. f 

Heredity 

Such  a  process  of  education  will  not  be  an  easy  matter.  There  are 
deep-rooted  convictions  which  will  have  to  be  overcome  by  the  accumu- 
lation of  indisputable  evidence,  which  must  be  largely  obtained  by  means 
of  qualified  statistical  research.  There  is  still  a  wide-spread  belief  that 
cancer  is  a  blood  disease,  frequently  inherited,  possibly  contracted  by 
infection,  and  in  any  event,  extremely  difficult  to  cure  or  control  by 
medical  or  surgical  means.  The  apprehensions  of  members  of  families  in 
which  one  or  more  cases  of  cancer  have  occurred  are  in  obvious  contra- 
diction to  the  available  evidence  that  cancer  is  not  inherited  in  the  strict 
sense  of  the  term,  and  that  the  probability  of  an  inheritance  of  a  predis- 
position to  cancer  is  relatively  remote  and  decidedly  less  than  in 
tuberculosis .  The  evidence  brought  together  on  this  point  in  the  chapter 
on  the  relation  of  the  cancer  problem  to  life  insurance  fully  sustains  the 
conclusion  that  the  available  facts  are  largely  of  a  negative  kind.  The 
conclusion  advanced  by  Rudolph  Schmidt,  that  "many  an  ancestral  tree 
that  has  been  studied,  scarcely  leaves  room  for  doubting  the  possibility 
of  direct  transmission,"  is  not  sustained  by  the  required  statistical 
evidence,  in  other  words,  by  a  sufficient  number  of  authentic  cases,  to  re- 
move the  margin  of  reasonable  doubt  as  regards  the  occurrence  of  mere 
coincidence  or  the  influence  of  collateral  factors,  such  as  an  inherited 

*Savill,  "System  of  Clinical  Medicine,"  New  York,  1912, 3d  edit.,  p.  589. 
^Journal  of  the  American  Medical  Association,  December  27, 1913. 

171 


THE  MORTALITY  FROM  CANCER 

exceptional  longevity  on  the  part  of  the  parents  and  their  offspring  from 
a  long  line  of  long-lived  ancestors,  or  the  continuity  of  almost  identical 
habits  and  modes  of  life  more  or  less  in  the  nature  of  predisposing 
causes.  Thus,  for  illustration,  it  is  possible  that  the  drinking-water  of 
a  community  may  act  as  a  chemical  irritant  and  as  such  have  a  strong 
influence  upon  the  body  fluids,  as  is  apparently  the  case  in  endemic 
goitre. 

Family  History 

The  number  of  separate  and  distinct  factors  which  condition  the  rela- 
tive frequency  of  cancer  among  the  different  types  of  mankind  entirely 
preclude  the  possibility  of  any  one  of  them  being  of  predominating  impor- 
tance. The  researches  of  Karl  Pearson,  including  the  family  history  of 
some  3,000  cancerous  persons  and  a  comparative  study  of  the  same 
number  of  non-cancerous  patients,  appear  to  establish  the  conclusion 
that  "there  was  practically  no  difference  between  them  in  respect  to  the 
prevalence  of  the  disease  among  their  relatives."  This  conclusion  is 
further  sustained  by  the  collective  experience  of  American  life  insurance 
companies  and  the  less  extensive  experience  of  The  Prudential.  Bash- 
ford,  in  a  well -written  argument  on  "Heredity  and  Disease"  presented 
to  the  Royal  Society  of  Medicine,  remarks  that  "Taking  the  surface  of 
the  body  as  an  example,  the  incidence  of  cancer  in  different  races  of 
mankind  is  characterized,  on  the  whole,  not  so  much  by  innate  racial 
peculiarities  as  determined  by  extrinsic  irritants.  Why  some  indi- 
viduals escape  the  consequence  of  peculiar  practices  involving  chronic 
irritation,  and  others  do  not,  it  is  at  present  impossible  to  decide.  Dis- 
regarding all  other  hypotheses,  we  fall  back  on  an  undefined  suscepti- 
bility of  the  body,  which  we  conceive  as  being  more  exaggerated  in  some 
persons  than  in  others.  There  is  certainly  no  evidence  for  the  inheri- 
tance of  cancer  as  such — only  the  possibility  of  a  predisposition  can  be 
discussed."  Bashford  refers  to  an  interesting  paper  by  W.  Harrison 
Cripps  on  "The  Relative  Frequency  with  Which  Cancer  is  Found  in  the 
Direct  Offspring  of  a  Cancerous  or  Non-cancerous  Parent,"  using  in 
addition  the  data  presented  by  Dr.  Ogle  in  the  Fifty-second  Annual 
Report  of  the  Registrar-General  of  England  and  Wales.  He  pro- 
vides the  required  statistical  evidence  that  "When  no  hereditary 
influence  is  assumed,  the  frequency  of  cancer  as  a  cause  of  death 
is  so  great  that  few  families  of  large  size  escape;  and  in  one  of 
every  two  families  either  a  parent  or  a  grandparent  will,  on  an 
average,  have  died  of  cancer,  supposing  such  parents  and  grandparents 
to  have  died  after  35  years  of  age,"  or  in  other  words,  "The  mor- 
tality from  cancer  is  so  great  that,  on  an  average,  in  one  of  two  families 
either  a  parent  or  a  grandparent  will  have  died  of  cancer  without 
assuming  hereditary  predisposition.  Hence  the  use  made  of  such 
records  to  prove  the  occurrence  of  a  large  number  of  cases  of  cancer  in  a 
selected  number  of  families  is  not  warranted." 

There  are  few  more  interesting  directions  in  which  qualified  statis- 
tical research  could  aid  the  scientific  study  of  the  cancer  problem  than 
by  an  extended  analysis  of  authentic  family  records  over  a  long  period  of 
years.  Unfortunately  such  records  are  extremely  difficult  to  secure, 
and  it  is  practically  impossible  to  give  due  weight  to  all  the  other  factors 

172 


OBSERVATIONS  AND  CONCLUSIONS 

and  conditions  likely  to  determine  the  rare  or  excessive  incidence  of 
cancer  met  with  in  exceptional  families  for  which  the  data  concerning 
cancer  may  be  available.* 

Cancer  Heredity  in  Mice 

The  experiments  on  animals  which  have  been  made  under  the  direc- 
tion of  cancer  research  funds  seem  to  establish  that  a  predisposition  to 
cancer  can  be  developed  under  given  conditions ;  but  it  is  not  at  all  likely 
that  the  artificial  laboratory  conditions  are  ever  experienced  in  actual 
life,  in  which  the  factor  of  variation  is  enormous.  Prof.  Tyzzer,  of 
Harvard,  has  investigated  the  life  history  of  a  family  of  mice  consisting  of 
100  individuals,  of  which  a  post-mortem  examination  was  made  imme- 
diately after  death.  Even  this  number  of  cases,  in  the  opinion  of  the 
author,  was  too  small  for  final  conclusions,  but  as  observed  by  Murray  in 
an  editorial  in  the  British  Medical  Journal,  "The  figures  are  certainly 
striking,  and  it  is  not  improbable  that  the  modern  view  that  heredity  has 
but  little  influence  in  regard  to  susceptibility  to  cancer  may  require  to  be 
modified  as  a  result  of  experimental  research."  Miss  MaudSlyeof  the 
Sprague  Memorial  Institute  of  Chicago  has  made  two  reports  upon  the 
incidence  and  inheritability  of  spontaneous  tumors  in  mice,  including 
observations  on  390  cases.  The  conclusions  of  Miss  Slye  are  summed  up 
in  the  brief  statement  that  "Cancer  is  probably  possible  in  any  mouse,  but 
it  is  likely  to  occur  where  heredity  predetermines,"  or  in  other  words, 
"Heredity  determines  in  which  cases  it  shall  develop  into  a  malignant 
cancer."  In  another  paper  by  the  same  author  the  statement  is  made 
that  "Hereditary  influences  show  a  marked  relation  to  the  occurrence  and 
character  of  lung  tumors.  Of  155  cases  investigated  from  this  standpoint 
there  was  a  tumor  ancestry  in  146,  and  in  but  9  of  the  cases  lung 
tumor  appeared  in  the  mice  without  tumor  ancestry." 

It  must  be  seriously  questioned  whether  these  conclusions  are  practi- 
cally applicable  to  the  consideration  of  cancer  as  a  human  problem.  The 
conditions  under  which  human  beings  grow  and  develop,  persist  and 
survive,  are  fundamentally  different  from  those  which  affect  animal  life. 
The  factors  of  deliberate  control  and  the  enormous  power  of  adaptability 
to  changing  environmental  conditions  utterly  preclude  the  possibility 
of  the  unrestrained  effect  of  possible  hereditary  tendencies  towards 
particular  diseases,  especially  cancer,  which,  as  a  rule,  occurs  very 
late  in  life,  when  the  degree  of  bodily  resistance,  on  the  one  hand,  and 
the  effect  of  special  habits  of  life,  on  the  other,  have  become  well  estab- 
lished and  assumed  a  power  equivalent  to  direction  and  control.  The 
same  analogy,  which  would  reduce  the  human  body  to  the  mechanism 
of  a  machine,  breaks  down  in  the  case  of  cancer  theories  which  would 
make  the  human  organism  conform  in  its  conscious  or  subconscious 
development  to  the  elementary  and  non-intelligible  mode  of  animal 
life.     In  other  words,  granting  the  possibility  of  direct  inlieritance  of  a 

*"Given  a  sufficient  number  of  families,  it  is  a  certainty,  even  if  there  be  no  such  thing  as  heredity,  that  of  at 
least  one  family,  say  ten  members  will  die  of  cancer.  The  only  absolute  proof  of  heredity  would  be  to  show  that 
cancer  occurred  frequently  in  certain  families,  and  practically  nowhere  else;  short  of  this  the  probability  of 
heredity  of  cancer  would  be  increased  if  it  could  be  shown  that  cancer  was  much  more  common  in  certain 
families  than  in  the  average  for  the  whole  community,  due  allowance  being  made  for  variations  in  age  and  sex- 
distribution."  (Newsholme's  "Elements  of  Vital  Statistics,"  p.  201,  quoted  in  the  George  Crocker  Special 
Research  Fund  Publication,  Vol.  i). 

173 


TEE  MORTALITY  FROM  CANCER 

predisposition  to  cancer,  the  numerous  external  factors  of  every-day 
life,  of  years  of  self -directed  effort,  of  changes  in  habits,  climate,  food, 
etc.,  all  preclude,  excepting  possibly  in  the  rarest  cases,  a  predetermined 
occurrence  of  cancer  in  the  offspring  of  a  cancerous  parent  under  the 
normal  conditions  of  human  existence.  The  discussion  on  the  subject 
of  heredity  in  cancer,  with  special  reference  to  the  laboratory  evidence 
of  such  a  transmission  in  the  case  of  mice,  is  summed  up  by  the  Journal 
of  the  American  Medical  Association  in  the  statement  that  "the  liahility 
is  the  thing  transmitted,  but  without  appropriate  conditions  the  effect 
is  not  produced ;  that  is,  heredity  modifies  the  character  or  degree  of  the 
effect  produced  by  a  common  injury,"  which  leaves  us  much  in  the  same 
position  as  before.  The  appropriate  conditions  do  not  repeat  them- 
selves in  the  normal  human  life;  but  if  cancer  is  the  result  of  local  ir- 
ritants, then  any  and  all  factors  which  contribute  towards  this  end  must 
have  their  influence,  although  a  single  factor  under  given  conditions, 
as  in  Kangri  cancer  or  X-ray  dermatitis,  may  be  so  self-evident  as 
to  preclude  the  possibility  of  collateral  or  contributory  causes  or  con- 
ditions. In  any  event,  the  available  evidence,  statistical  or  otherwise, 
does  not  sustain  the  conclusion  that  the  factor  of  human  heredity  is  of 
much  material  importance,  individually  or  collectively  considered. 
Cancer  and  Ovemutrition 
The  evidence  is  decidedly  more  conclusive  that  there  is  a  direct  rela- 
tion between  malnutrition  or  ovemutrition  and  cancer  frequency. 
The  relation  of  diet  to  cancer  has  been  discussed  in  some  detail  by  Dr. 
L.  D.  Bulkley  of  New  York,  who,  after  referring  to  the  question  as  to 
whether  there  is  not  some  deeper  fundamental  cause  lying  back  of  the 
trouble  which  should  be  reached  and  rectified  by  medical  skill  and 
acumen,  observes  that  "It  is  recognized  by  aU  that  the  tissues  develop 
and  are  maintained  by  nutrition  derived  from  the  food  and  drink  taken, 
and  tumors  all  certainly  grow  by  the  same  means.  For  years  it  has  been 
claimed  by  one  person  or  another  that  diet  has  more  or  less  influence 
in  the  production  of  cancer,  and  even  over  one  hundred  years  ago, 
Howard  Lambe  and  others  produced  strong  proof  to  show  the  effect 
of  diet  in  curing  certain  undoubted  cases  of  cancer  of  the  uterus,  the 
diagnosis  of  which  was  confirmed  by  prominent  surgeons  of  the  day." 
Even  earlier  than  this  Johann  Philip  Berchelmann,  in  a  treatise 
pubHshed  in  Frankfurt  a/M.,  1764,  attributed  cancer  to  the  acid 
and  corrosive  deterioration  of  the  lymphatic  glands  caused  by  the  excess 
of  hard,  common  acid  or  acid  and  fatty  sulphuric  substances  con- 
tained in  food  and  drink,  including  brandy,  cider,  etc.  He  also  men- 
tioned specifically  the  danger  of  an  excess  in  a  fish  diet,  particularly 
trout  and  eel,  as  well  as  oysters,  bread,  macaroni  and  pork.  The 
importance  of  these  early  references  lies  in  the  recognition  of  the  etio- 
logical significance  of  protein  excess  in  diet,  which  was  subsequently 
accepted  by  other  WT-iters,  particularly  Michel,  Dunn,  Williams,  and 
others.*  B.  F.  Glinsburg,  as  early  as  1853,  held  that  the  conditions 
responsible  for  corpulence  were  the  same  as  those  in  carcinoma.  In 
each  of  these  he  attributed  the  abnormahties  of  the  metabolism  to  the 
excess  of  an  albuminoid  diet. 

*J.  Wolff,  "Lehre  von  der  Krebskrankheit,"  Jena,  1911,  Vol.  ii,  p.  84. 

174 


OBSERVATIONS  AND  CONCLUSIONS 

Cancer  and  Metabolic  Disorders 

The  statistical  correlation  of  variations  in  cancer  frequency  and 
errors  and  defects  in  the  physiological  economy  of  nutrition  would  be 
extremely  difficult,  if  at  all  possible.  The  physiology  of  metabolism, 
regardless  of  a  truly  enormous  amount  of  literature,  is  as  yet  far  from 
having  reached  the  position  of  an  exact  science.  The  term  metabolism 
has  been  defined  as  "the  collective  chemical  changes  taking  place  in  living 
matter.  When  these  metabolic  changes  are  constructive,  as  in  the  building 
up  of  tissue  protoplasm  from  the  absorbed  food  material,  they  are  termed 
anabolic;  when  they  are  destructive,  as  in  the  breaking  down  of  living 
matter,  or  in  the  decomposition  of  materials  stored  up  in  tissues  and 
organs,  they  are  termed  katabolic."  As  further  explained  by  Prof. 
Chittenden:  "Proteid  metabolism,  or  more  exactly  proteid  katabolism, 
therefore,  means  the  destructive  decomposition  of  proteid  or  albuminous 
matter  in  the  living  body  and  is  pratically  synonymous  with  nitrogenous 
metabohsm,  since  the  entire  nitrogen  income  is  mainly  supplied  by  the 
proteids  or  albuminous  matters  of  the  food.* 

Based  up.on  more  general  considerations  the  opinion  has  frequently 
been  advanced  by  ancient  and  modern  writers  that  there  is  a  direct 
relation  between  diet  and  cancer  frequency,  and  particularly  has  this 
been  claimed  to  be  the  case  in  regard  to  the  excessive  consumption  of 
salt  and  meat.  The  per  capita  rise  in  the  meat  consumption  of  the 
principal  civilized  countries  has  been  referred  to  as  a  causative  factor 
in  the  corresponding  rise  in  the  cancer  death  rate.  The  statistical 
evidence,  however,  of  a  precise  correlation  of  cancer  frequency  to  per 
capita  meat  consumption  or  its  relative  infrequency  or  rarity  among 
vegetarians  has  not  been  established.  As  well  said  in  an  editorial  in  the 
New  York  Evening  Post  of  July  1,  1914,  "Admitting  that  meat  eating 
in  England  has  doubled  during  the  last  fifty  years,  there  are  a  number 
of  other  changes  quite  as  vital  that  have  taken  place  in  the  same  interval, 
and  it  would  be  the  height  of  rashness  to  assume  that  this  particular 
change  was  the  determining  factor."  This  argument  is  quite  conclusive, 
since,  as  frequently  pointed  out,  the  precise  correlation  of  any  single 
factor  to  cancer  frequency  is  extremely  difficult,  with  the  exception  of 
such  unusual  forms  of  malignant  disease  as  Kangri  cancer,  chimney- 
sweeps' cancer.  X-ray  dermatitis,  etc. 

Vegetarianism 

The  relation  of  vegetarianism  to  cancer  frequency  has  been  reported 
upon  in  considerable  detail  by  W.  R.  WilHams,  in  his  treatise  on  "The 
Natural  History  of  Cancer."t  He  observes  that  "It  may  be  well  to 
recall  the  fact  that  although  cancer  is  remarkably  rare  in  vegetarian 
communities,  yet  complete  exemption  cannot  be  claimed  for  such;  and 
the  like  is  true  of  herbivorous  as  compared  with  carnivorous."  He, 
however,  is  convinced  by  overwhelming  evidence  "that  the  incidence 
of  cancer  is  largely  conditioned  by  nutrition."  Investigations  along 
this  line  of  inquiry  should  be  made  with  a  due  regard  to  the  organ 
or  part  of  the  body  affected.  Nutrition  is  not  likely  to  have  any 
relation  whatever   to   the   occurrence   of  Kangri  cancer  or  chimney- 

*Chittenden,  "Physiological  Economy  in  Nutrition,"  p.  1. 
tW.  R.  Williams,  "The  Natural  History  of  Cancer,"  p.  350. 

175 
13 


TEE  MORTALITY  FROM  CANCER 

sweeps'  cancer,  but  there  is  quite  probably  a  determinable  relation 
between  gastric  cancer  and  serious  errors  in  nutrition  and  metabolism. 
Von  Noorden  holds  "That  a  purely  vegetable  diet  is  not  of  advantage 
to  the  majority  of  mankind  does  not  depend  on  any  peculiar  difference 
between  the  protein  of  plant  and  that  of  animal  origin,  but  is  the  result 
rather  of  the  presence  of  smaller  quantities  of  protein  in  vegetable  food, 
and  an  unequal  and  unsuitable  distribution  of  the  other  important  food 
stuffs  present,  as  well  as  of  certain  mechanical  intestinal  disturbances 
which  are  often  associated  with  a  diet  of  entirely  vegetable  origin."* 
With  special  reference  to  the  inffuence  of  cancer  upon  the  digestive 
processes.  Von  Noorden  mentions  the  investigations  of  Van  der  Velden 
pro^dng  the  absence  of  free  HCl  in  cases  of  cancer  of  the  stomach,  and 
the  confirmation  of  this  statement  by  many  subsequent  observers  and 
its  general  acceptance  at  the  present  time  as  one  of  the  most  .assured 
facts  in  the  pathology  of  the  diseases  of  the  stomach.  He  points  out 
that  there  are  chemical  changes  in  the  gastric  contents  which  result 
from  the  action  of  the  products  secreted  by  the  new  growth;  that  on  the 
basis  of  a  very  extended  series  of  observations  it  was  shown  that  there 
was  a  marked  diminution  in  the  secretion  of  hydrochloric  acid.  "But," 
as  he  observes,  "the  question  whether  the  development  of  cancer  has 
any  influence  on  intestinal  digestion  has  never  been  closely  and  com- 
prehensively studied,  because  the  specific  influence  on  the  functions 
of  the  intestine,  similar  to  that  which  has  been  believed  to  exist  in  the 
case  of  the  gastric  juice,  had  never  been  observed  or  asserted."  "Clinical 
experience,"  he  remarks,  ."teaches  that  cancer  of  the  stomach  is  not 
necessarily  followed  by  any  intestinal  .disturbances,  not  even  when 
characteristic  changes  of  the  gastric  functions,  such  as  a  deficiency  in 
HCl,  a  slight  disturbance  of  the  motility  of  the  stomach,  or  again,  a  f  orma- 
tion»of  lactic  acid,  could  be  clearly  demonstrated."  With  reference  to 
the  development  of  cancer  in  the  duodenum,  in  the  gall-bladder,  in 
the  liver  or  in  the  pancreas.  Von  Noorden  is  of  the  opinion  that  these 
may  be  considered  to  be  the  cause  of  disorders  of  the  biliary  or  pan- 
creatic secretion. t  Upon  the  important  question  as  to  the  effect  of  the 
development  of  cancer  upon  the  blood,  b'S  remarks  that  "During  the 
development  of  cancer  the  blood  frequently  undergoes  changes  which 
manifest  themselves  clinically  as  a  more  or  less  severe  ansemia.  Here 
again  it  is  especially  cancer  of  the  stomach  that  is  associated  with 

*Von  Noorden,  "Metabolism  and  Practical  Medicine,"  Vol.  i,  p.  3. 

tFor  some  extremely  suggestive  observations  and  conclusions  on  the  relation  of  diet  to  cancer  frequency 
under  experimental  conditions,  see  the  paper  on  "The  Rate  of  Tumor  Growth  in  Under-Fed  Hosts,"  by  Peyton 
Rous,  Proceedings  of  the  Society  for  Experimental  Biology  and  Medicine,  May  17,  1911.  Also,  address  on 
"The  Relation  of  Diets  and  of  Castration  to  the  Transmissible  Tumors  of  Rats  and  Mice,"  by  J.  E.  Sweet, 
EUen  P.  Corson- White  and  G.  J.  Saxon,  from  Journal  of  Biological  Chemistry,  July,  1913,  and  "The  Influence 
of  Diet  on  Transplanted  and  Spontaneous  Mouse  Tumors,"  by  Peyton  Rous,  Journal  of  Experimental  Medi- 
cine, No.  5,  1914.  Rous  observes  that  the  experimental  evidence  "shows  that  the  development  of  tumor 
grafts  can  in  many  cases  be  prevented  or  retarded  by  underfeeding  the  host  or  by  putting  it  on  a  special  diet." 
Corson-White  and  her  associates  conclude  that  "the  unfavorable  influence  of  poor  nutrition  (on  cancer  growth) 
as  brought  about  by  intercurrent  disease  upon  the  rate  of  growth  of  the  transplanted  tumor  is  a  matter  of 
general  observation."  They  refer  to  the  work  of  Mendel  and  Osborne,  "who  found  in  their  studies  of  the  effects 
of  feeding  rats  with  combinations  of  pure  vegetable  proteins  a  number  of  diets  which  completely  retarded  the 
normal  growth  of  the  animal,  although  the  general  condition  seemed  entirely  normal,"  and  they  say  that,  "in 
other  words,  their  animals  were  not  starved  in  any  sense  except  a  very  specific  one — certain  elements  necessary 
to  normal  growth  were  lacking."  The  implication  of  these  experiments  is  of  far-reaching  practical  importance. 
They  prove  at  least  as  regards  rats  and  mice  under  expected  condition  that  the  susceptibility  to  transplantable 
tumors  may  be  influenced  loth  positively  and  negatively  by  proper  diets,  and  the  same  conclusion  applies  to  the  rate 
of  growth  as  well  as  to  initial  susceptibility. 

176 


OBSERVATIONS  AND  CONCLUSIONS 

anaemia,  while  cancer  of  the  uterus  and  other  internal  organs  come 
next  in  order."  He  remarks,  however,  that  "Though  the  anaemia 
is  by  no  means  a  constant  symptom  of  the  growth  of  cancer,  some 
investigators  insist  on  its  being  a  specific  effect  of  the  hypothetical 
cancer  toxin,"* 

Diet  and  Cancer  Frequency 

These  extremely  involved  biochemical  aspects  of  the  cancer  problem 
are  largely  outside  of  the  field  of  statistical  research.  The  value  of  the 
evidence,  of  course,  is  proportionate  to  the  number  of  cases  considered, 
and  this  is  particularly  true  with  respect  to  the  comparative  frequency 
of  cancer  among  meat-eating  and  vegetarian  races.  In  the  discussion 
of  the  experience  data  of  life  insurance  companies  the  fact  was  brought 
out  that  the  proportion  of  deaths  from  cancer  among  Mohammedans 
in  the  experience  of  the  Oriental  Life  Insurance  Company  of  Bombay 
had  been  practically  negligible,  whereas  among  Europeans  the  pro- 
portionate mortality  from  this  cause  was  3.93  per  cent.  Williams, 
on  the  basis  of  a  world-survey,  came  to  the  conclusion  that  the  cancer 
death  rate  was  invariably  very  low  among  people  predominantly  poor, 
of  necessity  very  frugal,  subsisting  on  an  alimentation  comprising  but 
little  proteid  food.  "A  remarkable  negative  feature  of  reports  regarding 
cancer  frequency  in  India,"  according  to  the  same  authority,  "is  the 
almost  complete  absence  from  them  of  cases  of  malignant  disease  of  the 
stomach  (pylorus) ;  and  an  equally  noteworthy  positive  feature  is  the  un- 
usually great  predominance  of  external  cancers,"  particularly  of  the  male 
generative  organs.  Out  of  1,589  cases  of  cancer  reported  from  India 
and  analysed  by  the  Imperial  Cancer  Research  Fund,  1,513  involved 
the  external  surface  of  the  body,  and  only  76,  internal  organs.  The 
rarity  of  malignant  tumors  in  India  has  been  confirmed  by  the  researches 
of  liConard  Rogers,  on  the  basis  of  an  exhaustive  study  of  the  Calcutta 
post-mortem  records.  He  found  that  malignant  tumors  cause  only 
2.9  per  cent,  of  the  deaths  from  all  causes,  or  a  very  small  proportion 
compared  with  European  experience,  partly  accounted  for  by  the  low- 
age  incidence  of  the  subjects.  Out  of  1,000  autopsies,  only  1  was  a 
case  of  cancer  of  the  stomach;  2,  of  the  large  bowel;  4,  primary  cancer  of 
the  liver;  3,  primary  cancer  of  the  gall-bladder;  1,  of  the  bile-duct;  4,  of 
the  pancreas,  and  1,  of  the  fallopian  tube.  All  the  diagnoses  were 
verified  microscopically.  The  data  relate  only  to  post-mortems,  but 
it  is  pointed  out  by  Rogers  that  cancer  is  also  comparatively  rare  in  the 
surgical  series. 

Out  of  396  cases  of  carcinoma,  in  the  experience  of  the  Mayo  Hospital, 
in  Lahore,  during  the  decade  1892-1903  (270  males  and  126  females) 
72  were  cancers  of  the  male  generative  organ  (all  Hindoos) ;  58,  of  the 
skin ;  50,  of  the  breast ;  30,  of  the  rectum ;  23,  of  the  uterus ;  23,  of  the  liver ; 
20,  of  the  tongue;  13,  of  lip,  cheek,  mouth,  and  palate;  6,  of  the  bladder; 
5,  of  the  pharynx;  5,  of  the  larynx,  etc.  There  was  not  a  single  case  of 
malignant  disease  of  the  stomach  in  this  apparently  well-observed 
experience,  t 

*Von  Noorden,  "Metabolism  and  Practical  Medicine,"  Vol.  iii,  pp.  797-805. 
tW.  R.  Williams,  "The  Natural  History  of  Cancer,"  pp.  34-35. 

177 


THE  MORTALITY  FROM  CANCER 
Influence  of  Civilization 

The  available  evidence  would  seem  to  support  the  conclusion  that 
malignant  disease  of  the  stomach  is  relatively  much  less  frequent  among 
non-flesh-eating  races  than  among  those  not  confined  to  a  vegetarian  diet. 
Bulkley,  reporting  the  results  of  his  studies  during  a  rather  extensive  trip 
through  the  far  East,  states  that  although  he  met  a  large  number  of 
medical  men  and  made  personal  inquiries  at  hospitals  with  a  total  of 
many  thousands  of  patients,  in  Japan,  Corea,  China,  Philippines,  Siam 
and  Egj^pt,  he  met  everywhere  with  the  same  response:  "Cancer  was 
rarely  seen  among  vegetarian  peoples."  This  rather  sweeping  conclu- 
sion will  hardly'  hold  in  regard  to  external  cancers,  or  internal  cancers 
other  than  those  of  the  stomach  and  organs  and  parts  directly  related  to 
the  processes  of  nutrition.  Bulkley,  in  a  notable  paper  on  "The  Relation 
of  Diet  to  Cancer,"  holds  that  "with  advancing  civilization  the  diet 
has  become  more  and  more  complicated  and  luxury  and  over-eating  have 
increased:  this  is  especially  true  of  meat-eating  and  alcohol  and  coffee 
drinking.  .  .  .  Among  the  well-to-do  the  meat  consumption  has 
been  estimated  at  between  180  and  330  pounds  per  year.  Already  this  is 
much  more  than  double  the  amount  consumed  fifty  years  ago,  and  in  the 
same  time  the  deaths  from  cancer  have  increased  over  fourfold."*  If 
meat-eating,  as  such,  were  a  direct  cause  of  cancer  frequency,  it  would 
seem  reasonable  to  suppose  that  the  disease  should  be  exceptionally 
common  among  certain  tribes  of  North  American  Indians  who,  to  an 
unusual  extent,  five  upon  a  meat  diet.  As  a  matter  of  fact,  cancer  is 
apparently  very  rare  among  North  American  Indians,  at  least  as  far  as 
ascertainable  through  the  records  of  the  Division  of  Vital  Statistics  of 
the  United  States  Census.  In  the  year  1910  there  were  886  deaths  of 
Indians,  more  or  less  of  mixed  blood,  reported  for  the  registration  area, 
and  of  this  total  only  9,  or  1.02  per  cent.,  were  deaths  from  cancer  or 
other  malignant  tumors.  Of  this  number  6  were  cancers  of  the  stomach 
and  liver,  or  66.6  per  cent,  of  the  whole.  In  contrast,  out  of  1,055  deaths 
from  all  causes  among  Chinese  in  the  United  States  registration  area  in 
the  year  1910,  44  were  deaths  from  cancer  and  other  malignant  tumors, 
and  of  this  number  19,  or  43.2  per  cent.,  were  deaths  from  cancer  of  the 
stomach  and  liver.  These  data  are  confirmed  by  the  investigation  of  the 
George  Crocker  Special  Research  Fund. 

It  must  be  considered  extremely  doubtful  whether  the  operation  of  any 
single  factor  is  sufficient  to  induce  an  excess  in  the  normal  frequency  of 
cancer  among  human  beings,  even  though  the  evidence  may  be  quite 
conclusive  that  such  a  factor  operates  as  a  main  contributory  or  accelerat- 
ing condition.  Overeating  and,  even  more,  overnutrition  are  unquestion- 
ably most  important  contributory  causes  in  cancer  occurrence.  The 
principle  of  the  physiological  economy  of  nutrition  has  been  admirably 
set  forth  by  Prof.  Chittenden  in  the  statement  that 

There  is  no  question,  in  \-iew  of  our  results,  that  people  ordinarily  consume  much  more 
food  than  there  is  any  real  physiological  necessity  for,  and  it  is  more  than  probable  that 
this  excess  of  food  is  in  the  long  run  detrimental  to  health,  weakening  rather  than 
strengthening  the  body,  and  defeating  the  very  objects  aimed  at.  .  .  .  Physiological 
economy  in  nutrition  means  temperance,  and  not  prohibition.     It  means  full  freedom  of 

*Bulkley's  observations  and  conclusions  on  the  metabolism  of  cancer  and  the  relation  of  cancer  to  diet  have 
recently  been  published  under  the  title  "Cancer — Its  Cause  and  Treatment,"  New  York,  1915. 

178 


OBSERVATIONS  AND  CONCLUSIONS 

choice  in  the  selection  of  food.  It  is  not  cereal  diet  nor  vegetarianism,  but  it  is  in  the 
judicious  application  of  scientific  truth  to  the  art  of  living,  in  which  man  is  called  upon  to 
apply  to  himself  that  same  care  and  judgment  in  the  protection  of  his  bodily  machinery 
that  he  applies  to  the  mechanical  products  of  his  skill  and  creative  power.* 

Theory  of  Atra  Bills 

The  possible  biochemical  causes  of  cancer  have  not  as  yet  been  suf- 
ficiently investigated  to  justify  more  than  very  general  conclusions. 
The  statement  by  F.  W,  Forbes  Ross,  that  "so  far  as  my  researches  on 
epithelial  cancer  have  taken  me,  I  have  reason  to  believe  that  the  dis- 
turbance of  the  potassium  balance  in  the  body  is  the  cause,  or  one  of  the 
main  causes,  of  epithelial  cancer"  is  justified  as  a  hypothesis,  but  not  as  a 
final  conclusion.  An  equally  interesting  and  possibly  more  conclusive 
observation  in  this  connection  has  been  made  by  E.  F.  Wright  in  his 
treatise  on  "Plant  Disease  and  Its  Relation  to  Animal  Life":  "It  is 
clearly  proved  that  there  is  a  great  difference  in  the  composition  of  a 
healthy  or  normal  bile  and  of  the  bile  of  one  suffering  from  cancer." 
This  conclusion,  if  sound,  would  go  far  to  confirm  the  ancient  theory  of 
atra  bilis,  or  the  production  of  black  bile  by  the  renal  and  suprarenal 
glands,  and  its  effect  on  temperament  and  predisposition  to  generate 
tumors  of  all  kinds.  The  theory  of  black  bile  as  a  cause  of  cancer,  which 
prevailed  as  a  dogma  until  far  into  the  eighteenth  century,  was  a  mere 
fancy  of  the  imagination;  but  the  theory  that  an  abnormal  condition  of 
the  bile  may,  under  given  conditions,  be  due  to  cancerous  processes  rests 
upon  the  substantial  ground  of  precisely  determined  evidence.t 

Biochemical  Aspects 

It  is  in  the  direction  of  qualified  and  special  research  of  the  con- 
tributory factors  in  nutritional  disturbances  and  their  relation  to  can- 
cerous processes  that  the  most  valuable  results  of  cancer  research  are 
likely  to  be  had.  If,  for  illustration,  the  theory  of  Ross  is  true, 
that  the  artificial  or  intentional  regulation  of  the  potassium  balance 
in  an  apparently  hopeless  case  of  cancer  will  affect  a  profound  change 
for  the  better  in  the  disease,  it  is  self-evident  that  such  a  hypothesis 
is  entitled  to  much  weight.  The  main  object  in  all  cancer  research 
is  the  ascertainment  of  the  whole  truth  of  the  cancer  problem;  but  it  is 
also  important,  and  primarily  so,  to  determine  the  factors  or  processes 
contributory,  on  the  one  hand,  to  an  increase  in  the  cancer  death  rate, 
and  to  the  control  of  cancerous  conditions,  on  the  other. 

The  conclusion,  however,  by  the  same  writer  that  the  relative  cancer 
death  rates  of  England  and  Japan  negative  the  theory  of  the  influence 
of  a  vegetarian  diet  and  cancer  frequency  is  untenable,  because  of  the 
fact  elsewhere  discussed  that  the  mortality  by  organs  and  parts  varies 
considerably  in  the  two  countries.  For  illustration,  the  average  death 
rate  for  cancer  of  the  stomach  was  31.4  per  100,000  of  population 
for  England  and  Wales,  1906-10,  against  40.0  for  the  Empire  of  Japan, 
1909-10.  In  contrast,  the  mortality  from  cancer  of  the  breast  was 
17.9  per  100,000  of  women  in  England  and  Wales,  against  1.8  for  Japan. 

*Chittenden,  "Physiological  Economy  in  Nutrition,"  pp.  474-475. 

tPor  a  full  discussion  of  the  theory  of  atra  bilis,  see  J,  Wolff,  "Lehre  von  der  Krebskrankheit,"  Jena,  1907, 
Vol.  i,  pp.  1-53. 

179 


THE  MORTALITY  FROM  CANCER 

Exophthalmic  Goitre 

A  brief  consideration  seems  here  called  for  of  goitre  and  its  possible 
relation  to  the  cancer  problem.     Goitre  is  an  enlargement,  particularly 
if  hypertrophic,  of  the  thyroid  gland.    Anaemic,  or  exophthalmic  goitre, 
is    a  disease  characterized  by  cardiac  palpitation,  tremor  and  a  high 
pulse.     The  disease  is  more  common  among  women  than  among  men. 
The  etiology  is  obscure.     According  to  Gould  and  Pyle,  there  are  three 
theories  for  the  occurrence  of  exophthalmic  goitre:  1,  the  cardio-vascnlar, 
2,  the  mechanical,  3,  the  nervous.     None  of  these  explain  the  occurrence 
of  endemic  goitre,  the  etiology  of  which  was  reported  upon  in  the  Milroy 
Lectures,  delivered  at  the  Royal  College  of  Physicians  of  London,  1913, 
by  Robert  McCarrison  of  the  India  Medical  Service.      This  distin- 
guished author  examined  minutely  the  nature  of  the  goitrigenous  agency 
in  water  and  the  source  from  which  the  same  was  derived.     He  con- 
sidered the  geological  structure  of  the  soil  and  its  relationship  to  goitre, 
but  he  came  to  negative  conclusions,  to  the  effect  that  while  the  occur- 
rence of  goitre  was  very  much  more  commonly  associated  with  lime- 
stone and  dolomite  formations  and  with  marine  deposits  generally,  this 
association  was  not  a  constant  one;  for  not  only  were  these  formations 
often  entirely  free  from  the  disease,  but  goitre  could  and  did  prevail 
on  almost  every  other  geological  formation,  from  the  most  ancient  to 
the  most  modern.     He  was  unable,  also,  to  establish  a  correlation  be- 
tween the  amount  of  any  single  dissolved  ingredient  in  the  water  of 
goitrous  communities  that  could  De  detected  by  chemical  tests.     He 
was  willing  to  concede  that  hard  water  might  favor  the  action  of  the 
goitrigenous  agency,  but  he  held  that  such  waters  were  not  capable  by 
virtue  of  their  hardness  alone  of  causing  goitre.     In  regard  to  radio- 
active substances  in  the  waters  of  goitrous  communities,  he  refers  to  the 
researches  of  Repin,  and  the  conclusion  that  "These  waters  exercise  on 
the  general  metabolism  a  powerful  action  of  which  the  thyroid  hyper- 
trophy is  the  only  reverberation."     He  quotes  the  same  authority  to 
the  effect:     "That   goitrigenous   water  is  invariably  mineral  water; 
that  in  this  water  exists  some  chemical  ingredient — ^possibly  salts  of 
lime  and  magnesium,  possibly  radio-active  substances— which  is  the 
active  principle  in  the  production  of  goitre."     This  view  was  not 
accepted  by  McCarrison,  particularly  on  the  ground  of  the  researches 
of  the  Swiss  Goitre  Commission,  which  prove  that  "Goitrous  waters 
almost  invariably  showed  an  infinitely  higher  bacterial  content  than 
innocuous  waters,"  and  the  fact  that  in  radio-active  waters  the  bacterial 
content  was  low.     Without  enlarging  upon  the  extremely  technical 
aspects  of  the  etiology  of  endemic  goitre,  it  appears  that  the  conclusion  of 
McCarrison,  based  upon  and  sustained  by  the  findings  of  the  Swiss  Goitre 
Commission,  is  that  "Goitre-producing  waters  are  eminently  those  in 
which  micro-organisms  find  the  nutrient  materials  for  their  life  and 

growth." 

Endemic  Goitre  in  Fish 

The  importance  of  these  considerations  are  emphasized  in  the  value 
attached  to  the  investigations  by  Gaylord  and  others,  in  cooperation 
with  the  United  States  Fish  Commission,  into  the  occurrence  of  endemic 
goitre,  or  more  accurately,  thyroid  carcinoma  among  artificially  bred 

180 


OBSERVATIONS  AND  CONCLUSIONS 

trout.  McCarrison  refers  to  the  investigation  by  Marine  and  Lenhart, 
stating  that  "Overfeeding,  overcrowding,  and  a  hmited  water-supply, 
are  the  major  factors  in  the  production  of  filthy,  unhygienic  tanks  or 
ponds,  and  the  unsanitary,  unhygienic  and  filthy  tanks  are  in  a  very 
important  but  still  unknown  manner  associated  with  the  development 
of  thyroid  hyperplasia."  Gaylord's  observations  were  found  to  be  in 
complete  agreement  with  the  findings  of  Marine  and  Lenhart.  A  table 
is  given  showing  the  increase  in  the  prevalence  of  the  disease  from  non- 
occurrence in  the  upper  tanks  to  3  per  cent,  goitrous  in  the  first  tank, 
8  per  cent,  in  the  second,  45  per  cent,  in  the  third,  and  84  per  cent, 
in  the  fourth.  These  interesting  results  are  further  confirmed  by  the 
goitre  investigations  in  the  villages  of  Gilgit,  India,  made  bj''  McCar- 
rison in  1905.  In  that  case,  there  was  "the  same  increased  prevalence 
of  the  disease  as  the  water  became  more  polluted,  and  a  diminution 
in  the  amount  of  the  disease  as  a  result  of  dilution  of  the  impure  water 
with  fresh  spring  water."  The  markedly  place-character  of  the  disease, 
even  in  the  case  of  trout,  was  therefore  well  illustrated.  Marine  and 
Lenhart  had  arrived  at  the  conclusion,  as  a  result  of  their  observations, 
that  goitre  was  "the  symptomatic  manifestation  of  a  metabolic  and 
nutritional  disturbance,  and  that  food  was  the  major  factor  acting  to 
bring  about  a  fault  of  nutrition  favorable  for  goitre  development." 
This  conclusion  was  not  accepted  by  McCarrison,  who  considered  it 
inconsistent  with  some  of  the  facts  and  opposed  to  the  theory  advanced 
by  him  of  a  micro-organism  as  a  satisfactory  explanation  of  the  develop- 
ment of  the  disease  in  artificially  bred  trout. 

Thyroid  Carcinoma* 
Gaylord  and  Marsh  of  the  New  York  State  Institute  for  the  Study 
of  Malignant  Disease,  in  an  elaborate  report  on  "Carcinoma  of  the 
Thyroid  in  Salmonoid  Fishes,"  published  by  the  United  States  Bureau 
of  Fisheries,  1914,  conclude  that  "The  disease  known  as  thyroid  tumor, 
endemic  goitre,  or  carcinoma  of  the  thyroid  in  the  Salmonidae,  is  a  malig- 
nant neoplasm ;  that  it  occurs  in  fish  living  under  conditions  of  freedom  in 
populated  areas;  that  when  introduced  into  fish-breeding  establishments 
it  becomes  endemic,  with  occasional  epidemic  outbreaks;  that  normal  fish 
taken  from  the  wilderness  may  be  made  to  acquire  the  disease  when  placed 
in  fish-breeding  establishments  where  the  disease  is  endemic;  that  the 
feeding  of  uncooked  animal  proteid  favors  and  the  feeding  of  cooked 
animal  proteid  retards  the  disease  as  compared  with  the  uncooked; 
but  that  feeding  alone  is  not  an  efiicient  cause."  They  therefore  hold 
that  "There  must  be  a  transmitting  agent,  probably  through  the  water 
or  food,  or  both,"  and  that  "By  scraping  the  inner  surface  of  water- 
soaked  wooden  troughs  in  which  the  disease  was  endemic,  they  secured 
an  agent  which  from  its  action  upon  the  mammalian  thyroid  when  ad- 
ministered through  drinking  water  was  no  doubt  the  cause  of  the  dis- 
ease in  the  fish  confined  in  these  troughs."     They  found  that  the  agent 

The  mortality  from  goitre  in  the  United  States  Registration  Area  is  14.1  per  1 ,000,000  of  population  (1910-13) . 
For  males  the  rate  was  3.0,  and  for  females  25.8.  For  England  and  Wales  (1911-12)  the  rate  was  11.4 
per  1,000,000  for  both  sexes  combined;  2.1  for  males,  and  20.1  for  females.  For  the  Eastern  States  in  the  United 
States  Registration  Area  the  goitre  mortality  rate  was  11.3;  for  the  Southern  States,  6.1 ;  for  the  Central  States, 
20.2;  for  the  Rocky  Mountain  States,  10.6;  and  for  the  Pacific  Coast  States,  12.4.  The  highest  rates  prevailed 
in  an  almost  contiguous  area,  as  follows:  Michigan,  24.9,  Indiana,  22.0,  Ohio,  21.2,  Wisconsin,  18.6,  and 
Minnesota,  18.1.    All  of  these  rates  are  decidedly  above  the  average  for  the  registration  area  as  a  whole. 

181 


THE  MORTALITY  FROM  CANCER 

could  be  destroyed  by  boiling,  and  that  fish  in  all  stages  of  the  disease 
were  favorably  affected  in  the  direction  of  cure  by  the  addition  to  the 
water  supply  in  suitable  concentration  of  mercury,  arsenic  or  iodine. 
They  therefore  advance  the  very  important  general  conclusion  that 
the  effect  of  mercury,  arsenic  and  iodine  in  carcinoma  of  the  thyroid  in 
fish  and  the  subsequent  positive  experiments  with  metals  in  mammalian 
cancer  are  probably  the  expression  of  a  therapeutic  relation  of  these 
elements  to  carcinoma.  They  found  that  certain  species  of  the  Sal- 
monidae  had  an  almost  complete  natural  resistance  to  the  disease,  and 
that  certain  lots  of  fish  of  susceptible  species  show  a  high  degree  of 
immunity  to  the  disease;  that  spontaneous  recovery  occurs  in  a  con- 
siderable percentage  of  individuals;  that  removal  from  ponds  in  which 
the  disease  is  endemic  to  natural  conditions  or  a  change  to  more  natural 
food  increases  the  percentage  of  spontaneous  recoveries;  and  that  such 
a  recovery  appeared  to  confer  a  degree  of  immunity  against  recurrence.* 
Following  these  extremely  interesting  and  apparently  thoroughly  scien- 
tific investigations  and  conclusions,  the  authors  maintain  that  the  disease 
known  as  endemic  goitre,  or  carcinoma  of  the  thyroid,  is  endemic  in 
a  very  high  percentage  of  all  trout  hatcheries  in  the  United  States,  and 
that  "The  occurrence  of  the  disease  in  wild  fish,  its  introduction  into 
fish-cultural  stations,  its  localization  in  certain  troughs  or  water  sup- 
plies, the  method  of  its  spread,  its  transmission  to  mammals,  the  efficacy 
of  certain  well-known  inorganic  germicides  in  the  treatment  of  the  dis- 
ease, the  destruction  of  the  agent  by  boiling,  the  phenomena  of  the 
spontaneous  recovery  and  immunity,  strongly  indicate  that  the  agent 
causing  the  disease  is  a  living  organism."  But  they  add,  "No  evidence 
has  yet  been  produced  to  indicate  the  direct  transmission  of  the  disease 
from  individual  to  individual."t 

It  has  seemed  advisable  to  add  the  foregoing  rather  extended  observa- 
tions on  goitre  in  human  beings  and  in  the  salmonoid  fishes  as  an 
exceptionally  interesting  contribution  to  the  theory  that  cancer  and 
allied  diseases  are  primarily  conditioned  by  errors  or  defects  in  nutrition 
and  metabolism,  and  that,  therefore,  the  underlying  principal  cause  of 
cancer  frequency  is  a  wide  departure  in  modern  life  from  the  normal 
mode  typical  of  primitive  races,  among  whom,  as  far  as  known,  cancer 
is  in  all  of  its  forms  of  comparatively  rare  occurrence.  A  full  dis- 
cussion of  this  phase  of  the  cancer  problem  does  not  come  within  the 
scope  and  plan  of  the  present  work.  There  is,  however,  an  obvious 
possibility  that  statistical  research,  particularly  in  the  direction  of 
determining  with  precision  the  local  geographical  incidence  of  the  dis- 
ease and  its  direct  correlation  to  the  more  important  contributory 
factors,  but  especially  to  the  diet  and  nutrition  of  the  population  affected, 

*Bulletiii  of  the  U.  S.  Bureau  of  Fisheries,  Carcinoma  of  the  Thyroid  in  Salmonoid  Fishes,  p.  506. 

fThe  subject  of  thyroid  carcinoma  and  the  cause  of  goitre  in  fish  are  briefly  referred  to  in  the  Cancer  Studies 
by  the  George  Crocker  Special  Cancer  Research  Fund,  Vol.  i,  pp.  242-243,  as  follows:  "There  are  no  evidences 
that  the  disorder  was  either  infectious  or  contagious,  but  much  in  favor  of  the  view  that  it  was  the  symptomatic 
manifestation  of  a  metabolic  and  nutritional  disturbance.  .  .  .  Limited  water  supply,  overcrowding,  and 
overfeeding  with  a  higlily  artificial  and  incomplete  food.  The  water  of  the  hatchery  was  not  intrinsically  goitre- 
producing,  because  fish  would  not  develop  the  disease  unless  at  least  the  factor  of  overfeeding  with  an  incomplete 
food  were  in  operation,  and  because  they  recovered  if  the  overfeeding  and  overcrowding  were  corrected,  even 
though  remaining  in  the  same  pond.  Therefore  it  seemed  probable  that  food  was  the  major  factor  in  bringing 
about  some  fault  of  nutrition  favorable  to  goitre  development,  although  it  was  impossible  to  suggest  whet 
elements  in  the  diet  were  implicated." 

182 


OBSERJ^TIONS  AND  CONCLUSIONS 

may  prove  of  great  practical  value  in  the  ascertainment  of  the  specific 

factors  or  conditions  chiefly  responsible  for  an  excess  in  cancer  frequency 

in  particular  localities.  ,  ^, 

Cancer  and  Obesity 

The  evidence  elsewhere  introduced  in  this  work  regarding  the  cor- 
relation of  overweight  to  cancer  frequency  is  as  yet  inconclusive.  As  a 
single  factor  the  importance  of  overweight  in  relation  to  cancer  can 
easily  be  exaggerated.  Obesity  is,  broadly  speaking,  "an  excessive 
development  of  fat  throughout  the  body,  and  it  usually  occurs  after  the 
prime  of  life,  but  it  may  be  congenital,  or  may  occur  at  any  period  of 
life."  "Oljesity,"  according  to  French's  "Practice  of  Medicine,"  "is  the 
peculiar  state  of  body  in  which,  probably  as  a  result  of  abnormal  nutri- 
tion, there  is  an  excessive  accumulation  of  adipose  tissue.  .  .  .  The 
principal  causes  that  lead  to  it  jare  excess  of  food  and  drink,  especially 
of  starches,  sugars  and  malt  liquors,  with  deficient  exercise,  yet  many 
fleshy  persons  are  remarkably  abstemious  and  some  are  overcome  with 
fat  in  the  midst  of  an  active  life."  Overfeeding  is  here  confused  with 
malnutrition,  which  is  not  the  exact  equivalent  of  overnutrition. 

Rabagliati  emphasizes  the  importance  of  connective-tissue  con- 
gestion and  the  relation,  therefore,  of  cancer  to  rheumatism.  He  holds 
that  wrong  alimentation  gains  power  as  age  advances,  and  that  the 
increasing  weight  of  authority  is  in  favor  of  the  view  that  cancer  is  a 
food  disease.  He  brings  out  the  important  point  that  the  reason  why 
cancer  is  rare  in  childhood  and  early  life  is  because  the  irritation  of  the 
organism  is  accompanied  by  intolerance  and  followed  by  infectious 
fevers  and  inflammation,  whereas  in  middle  life  "the  organism  being 
weighed  down  and  oppressed  by  the  excessive  load  it  is  compelled  to 
carry,  and  the  tissues  being  somewhat  resistant,  it  does  not  intolerantly 
react  against  the  irritation  into  a  high  fever,  but  on  the  other  hand  is 
simply  depressed  by  it."  He  explains  why  cancer  becomes  less  com- 
mon over  65  years  of  age  by  holding  that  "persons  by  that  time  have 
learned  how  to  live,  and  those  who  have  not  learned  or  who  would  not 
learn  have  been  swept  away  by  some  of  the  chronic,  or  by  some  of  the 
acute  illnesses."  His  final  conclusion  is  that  "Too  many  meals,  and 
especially  when  they  contain  too  large  a  proportion  of  the  carbonaceous 
and  fermenting  foods,  form  a  main  part  of  the  predisposing  cause  of 

cancer." 

Alcohol  and  Chronic  Irritation 

Abuse  in  food  and  abuse  in  drink  are  closely  related.    Chronic  irritation 

as  a  result  of  overindulgence  may  safely  be  considered  a  predisposing  factor 

in  at  least  the  occurrence  of  cancer  of  the  stomach.     Some  early  writers 

on  cancer  attributed  the  disease  to  the  general  use  of  acid  wines  and 

cider.     The  available  evidence,  however,  is  not  conclusive,  further  than 

that  excessive  indulgence  in  alcoholic  drinks  is  quite  likely  to  produce  a 

chronic  gastritis,  which  requires  to  be  considered  as  a  precancerous 

disease.    Hepatic  cirrhosis  is  induced  in  chronic  alcoholism  in  many  cases, 

but  especially  in  those  who  habitually  take  whiskey  undiluted  into  an 

empty  stomach.     This  habit  is  certainly  not  very  general  in  this  country. 

The  common  use  of  raw  whiskey  has  been  connected  by  Boas  with  cancer 

of  the  oesophagus.     Reyburn,  in  an  interesting  discussion  of  the  medical 

treatment  of  cancer  considers  the  influence  of  alcohol  as  a  predisposing 

183 


TEE  MORTALITY  FROM  CANCER 

cause  in  cancer,  particularly  as  regards  the  insidious  and  dangerous  effect 
of  alcohol  on  the  tissues,  even  from  small  quantities,  when  taken  regularly, 
and  the  effect  of  alcohol  in  the  dilute  form  to  enter  into  the  blood  and 
then  circulate  in  the  blood  through  every  tissue  and  organ  of  the  body.* 
He  therefore  concludes  that  the  effect  of  this  is  that  "The  alcohol,  by 
powerful  affinity  for  the  water  of  the  tissues,  dehydrates  and  prematurely 
hardens  them ;  not  only  this,  but  alcohol  is  a  retarderof  waste  in  the  body." 
Sir  Alfred  Pearce  Gould,  in  the  Bradshaw  Lecture  on  Cancer,  reported 
in  the  British  Medical  Journal  for  December  10, 1910,  considers  alcohol 
an  etiological  factor  of  considerable  importance.     Referring  to  the  occu- 
pational  mortality   statistics,  according  to  which   persons  connected 
with  the  liquor  traffic  show  an  exceptionally  high  mortality  figure  from 
cancer,  he  concludes  that  "the  cancer  incidence  in  any  trade  varies  with 
the  attendant  habits  as  regards  alcohol;"  and  from  the  point  of  view  of 
chronic  irritation,  X-rays  and  alcohol — these  so-called  causes  of  can- 
cer— agree  in  being  conditions  that  wear  out  the  cells  of  a  part :  they 
add  to  the  number  of  cell  generations,  they  deteriorate  the  evolution 
of  the  individual  cell,  they  appear  to  lessen  the  hold  over  the  cell  of  the 
great  primal  cell  law,  and  singly  or  in  combination  they  cause  cancer. 
There  is  serious  risk,  however,  in  carrying  this  conclusion  too  far.     A  few 
years  ago  a  report  was  published  on  the  experience  of  Inebriate  Asylums 
in  England,  according  to  which  "the  mortality  from  cancer  was  more 
than  eight  times  greater  than  that  which  obtains  throughout  the  coun- 
try."    This  startling  conclusion  was  subjected  to  critical  analysis  in  a 
Second  Study  of  Extreme  Alcoholism  in  Adults,  by  David  Heron,  Galton 
Research    Fellow,   of   the  Francis   Galton  Laboratory  for   National 
Eugenics,  with  the  result  that  the  very  opposite  conclusion  was  arrived 
at,  or  in  other  words,  the  frequency  of  cancer  was  found  to  be  less 
among  inebriates   than  among   the  general  population.      Bainbridge 
points   out    that   the    prejudicial   influence   of    alcohol   on  cancer   is 
a  debatable  question,  but  he  observes,  "In  the  case  of  the  alimen- 
tary canal,  at  any  rate,  this  possibility  has  been  practically  estab- 
lished by  the  greater  frequency  with  which  males  suffer  from  cancer 
of  the  upper  half  of  the  alimentary  canal  and  stomach,  especially  in 
occupations  prone  to  alcoholic  indulgence."!    Hastings  Gilford,  in  his 
treatise  on  "Disorders  of  Post-Natal  Growth  and  Development,"  con- 
cludes that  there  is  no  clear  evidence  that  cancer  in  general  is  due  to  the 
drinking  of  alcoholic  intoxicants.  He  quotes  Dr.  Snow  J  as  one  who  in  com- 
mon with  many  other  observers  believes  that  alcohol  has  a  conspicuous 
share  in  giving  rise  to  cancer  of  the  lips  and  tongue.     He  also  quotes  Sir 
Victor  Horsley,  to  the  effect  that  "There  is  a  great  excess  of  [malignant] 
disease  in  persons  employed  in  those  occupations  in  which  alcoholic  indul- 
gence is  common,"  and  "This  is  not  surprising  when  we  remember  that  one 
of  the  factors  producing  cancer  is  the  influence  of  chronic  irritation,  and 
alcohol  causes  irritation  of  the  tissues  with  which  it  comes  in  contact." 
There  can  be  no  question  of  doubt  but  that  alcohol  is  a  cause  of  degenera- 
tion, and  Gilford  elsewhere  observes  that  "the  tissues  of  the  alcohol  drink- 
er are  more  vulnerable  than  the  water  drinker,  and  that,  furthermore, 

*  Journal  of  the  American  Medical  Association,  November  10,  1906, 

tWilliam  Seaman  Bainbridge,  "The  Cancer  Problem,"  p.  81. 

tThe  Lancet,  1904,  Vol.  ii,  p.  822.     (See  also  "Disorders  of  Post-Natal  Growth  and  Development,"  p.  162.) 

184 


OBSERmriONS  AND  CONCLUSIONS 

the  stimulating  effect  of  alcohol  is  to  a  large  extent  the  result  of  an 
increased  flow  of  blood,  not  founded  on  physiological  reasons,  and  any 
increase  of  gastric  juice,  any  extra  warmth  of  the  skin  or  exaltation  of 
mind  so  produced  is  pathological,  for  it  is  due  to  a  morbid  congestion 
and  not  to  a  natural  flush.  The  action  of  alcohol  upon  the  healthy 
stomach  is  essentially  that  of  a  disorder,  and  carries  with  it  all  the 
evil  which  the  word  implies." 

In  the  cancer  investigation  in  Baden  one  of  the  predisposing  conditions 
determined  with  approximate  accuracy  was  alcoholism,  which  accounted 
for  about  7.5  per  cent,  of  the  cases  returned  for  the  year  1904  and  6.25 
per  cent,  for  the  year  1906.  In  contrast,  nicotine  abuse,  or  smoking  in 
any  form,  was  accounted  for  in  only  1  per  cent,  of  the  cases  for  1904 
and  0.75  per  cent,  for  the  year  1906.  Even  chronic  inflammation  and 
irritations  caused  by  gall-stones,  etc.,  accounted  for  a  smaller  proportion 
of  cases  than  alcoholic  misuse. 

Smoking  and  Chronic  Irritation 

Alcohol  and  tobacco  are  unquestionably  sources  of  chronic  irritation 
in  the  mouth  and  throat.  The  relation  of  smoking  to  cancer  of  the 
buccal  cavity  is  apparently  so  well  established  as  not  to  admit  of  even  a 
question  of  doubt.  Betel-nut  chewing  may  here  be  referred  to  as  an 
etiological  factor  within  the  same  category.  As  pointed  out  by  Childe, 
in  his  treatise  on  "The  Control  of  a  Scourge,"  if  oversmoking,  or 
smoking  at  all,  irritates  the  mouth  and  tongue  and  gives  a  feeling  of 
soreness,  it  is  advisable  to  discontinue  the  practice,  and  he  particularly 
suggests  the  abolition  of  the  clay  pipe.  The  subject  was  inquired  into  in 
connection  with  the  special  cancer  investigation  in  Ireland,  published  as  a 
supplement  to  the  thirty-eighth  detailed  annual  report  of  the  Registrar- 
General,  Dublin,  1903.  On  the  basis  of  this  investigation  the  conclusion 
was  arrived  at  "that  in  some  cases  cancer  has  supervened  where  there  has 
been  irritation  of  the  lip  consequent  on  smoking  clay  pipes.  W.  R. 
Williams  in  summarizing  the  available  evidence  on  the  relation  of 
smoking  to  lingual  and  buccal  cancer,  concludes,  however,  that  intrinsic 
causes  are  much  more  important  factors  in  the  origination  of  cancer  than 
extrinsic  ones,  which  are  by  no  means  its  necessary  antecedents.  The 
fact,  however,  that  the  mortality  among  males  from  cancer  of  the  buccal 
cavity  is  almost  invariably  greatly  in  excess  of  the  corresponding  death 
rate  for  females  is  in  itself  indicative  of  the  etiological  importance  of 
smoking.  An  extremely  suggestive  illustration  in  support  of  this  con- 
clusion is  the  relatively  high  mortality  from  cancer  of  the  buccal  cavity 
among  aged  negro  women  in  the  District  of  Columbia,  who  are  given  to 
the  smoking  of  clay  pipes;  this  habit  is  practically  unknown  among 
white  women.  For  ages  over  40  the  death  rate  for  cancer  of  the  buccal 
cavity  in  the  District  of  Columbia  was  3.3  per  100,000  of  population  for 
white  women,  against  8.4  for  colored  women;  but  at  ages  70  and  over  the 
rates  were  8.6  and  30.1,  respectively.* 

W.  S.  Lazarus-Barlow  in  the  Croonian  Lectures  on  Radio-Activity  and 
Carcinoma,  calls  attention  to  the  fact  that  the  liability  to  cancer  of  the 
lip  undergoes  no  diminution  in  old  age,  such  as  is  observed  in  the  case  of 
carcinoma  in  all  other  sites  examined  by  him.     This  he  considers  strong 

•"Menace  of  Cancer,"  p.  24 

185 


THE  MORTALITY  FROM  CANCER 

evidence  that  some  fundamentally  different  condition  obtains  in  the  two 
situations,  and  he  therefore  concludes  that  "The  persistency  with  which 
the  old  man  clings  to  his  pipe,  holding  it  between  his  lips,  whether  actu- 
ally smoking  or  not,  whether  awake  or  dozing,  as  he  sits  in  the  sun  or  by 
the  fireside,  is  as  characteristic  of  the  ages  above  seventy  as  is  the  tooth- 
less condition  which  commences  to  set  in  about  65.  On  the  assumption 
that  the  pipe  is  in  some  way  related  to  carcinoma  of  the  lip,  while  the 
teeth  are  in  some  way  related  to  carcinoma  of  the  tongue  and  other  parts 
of  the  mouth,  the  curve  of  liability  to  this  disease  in  the  two  situations 
should  be  exactly  as  we  find  them  to  be."* 

These  conclusions  of  one  of  the  foremost  students  of  the  cancer  prob- 
lem are  based  in  part  upon  the  results  of  extended  studies  regarding 
the  radio-active  properties  of  clay  pipes,  which,  however,  are  too  tech- 
nical to  be  more  than  referred  to.  Dr.  Louis  Bradford  Couch  in  a  con- 
tribution to  the  Medical  Times,  November,  1911,  approaching  the  sub- 
ject from  another  point  of  view,  points  out  that  the  smoking  of  tobacco 
produces  CO  and  CO2.  "The  latter,"  he  remarks,  "unites  with  the 
watery  secretions  of  the  mouth  and  lips,  forming  carbonic  acid,  the  same 
factor  involved  by  fermentation  in  the  traumatized  tissues,  while  the 
mechanical  pressure  of  the  pipe  held  regularly  in  one  place  on  the  lip, 
causes  blood  stagnation  and  local  fermentation  and  poisoning  by  its 
resulting  gases."  He  also  directs  attention  to  a  fact  of  considerable 
interest,  in  support  of  which,  however,  the  required  statistical  evidence 
is  not  given,  that  "Cancerous  growths  always  occur  on  the  lower  lip, 
never  on  the  upper  lip,"t  which  fact,  he  contends,  "corroborates  my 
theories  as  regards  the  importance  of  pressure  and  fermentation."  In 
other  words,  "The  irritating  character  of  the  nicotine  and  pyridine  that 
bathe  the  stem  of  the  pipe  as  it  presses  on  the  lip,  are  factors  of  impor- 
tance. In  smokers'  cancer  there  are  three  active  causes  at  work,  i.  e., 
the  pressure  of  the  pipe  inducing  stagnation  of  blood  and  fermentation 
of  the  tissues;  nerve  irritation  induced  by  nicotine  and  pyridine;  the 
mucous  absorption  of  the  gases  of  combustion,  which  alone  and  unaided 
cause  vascular  paralysis,  resulting  in  fibrous  exudations,  which,  becom- 
ing organized,  cause  the  tumerous  growth." 

The  relation  of  cancer  of  the  buccal  cavity,  and  particularly  of  the 
lips,  to  smoking  habits  was  also  considered  in  the  German  Cancer 
Census  of  1902.  The  conclusion  is  advanced  that  the  greater  fre- 
quency of  cancer  of  the  lips  among  men  is  directly  attributable  to  the 
smoking  habit,  and  the  evidence  of  tobacco  misuse  was  apparently 
established  in  nearly  16  per  cent,  of  the  male  cancer  cases.  It  is  pointed 
out,  however,  that  the  habit  of  smoking  is  not  to  be  considered  a  direct 
causative  factor,  but  only  in  the  sense  of  being  a  contributory  one,  in 
identically  the  same  way  as  it  is  held  that  alcoholism  requires  to  be 
considered  a  contributory  instead  of  a  direct  cause  in  cancer  frequency. 
Gall-stones  and  Chronic  Irritation 

The  foregoing  considerations  emphasize  the  practical  possibilities  of  an 
extension  of  the  method  of  qualified  statistical  research  to  special  phases 

'British  Medical  Journal,  June  26,  1909. 

fThe  accuracy  of  this  statement,  however,  is  seriously  questioned  by  one  of  the  foremost  authorities  on 
this  particular  aspect  of  the  cancer  problem.  The  statement  is  of  special  significance  as  an  indication  of  the 
practical  importance  of  detailed  statistical  data  regarding  the  precise  location  of  the  cancerous  growth. 

186 


OBSERVATIONS  AND  CONCLUSIONS 

of  the  cancer  problem.  Most  of  the  theories  advanced  with  regard  to 
special  contributory  factors  in  cancer  occurrence  are  insufficiently  sus- 
tained by  the  necessary  statistical  evidence.  The  precise  seat  of  local 
irritation  should  in  all  cases  be  correctly  determined,  but  unfortunately 
it  is  in  this  direction  that  most  of  the  general  cancer  studies  fall  short 
of  the  required  degree  of  scientific  conclusiveness.  The  confusion  of 
cause  and  effect  is  as  common  in  the  cancer  problem  as  in  tuber- 
culosis. The  several  factors  in  their  interrelation  are  no  doubt  often 
obscure.  The  division  by  Dr.  WiUiam  J.  Mayo  of  local  irritation  into, 
first,  congenital  or  acquired  neoplasms,  such  as  moles,  warts  and  benign 
tumors,  which  might  undergo  malignancy,  second,  trauma,  which 
strongly  influences  the  development  not  only  of  sarcoma  but  also  of 
carcinoma,  third,  chronic  irritation,  which  is  perhaps  the  most  im- 
portant of  all  precancerous  conditions,  whether  the  result  of  mechanical, 
chemical  or  infectious  agencies,  is  suggestive  of  the  extreme  complexity 
of  the  biological  aspects  of  the  cancer  problem  statistically  considered. 
Among  the  illustrations  given  by  Mayo  are  cancer  of  the  gall-bladder 
from  gall-stone  irritations  and  cancer  of  the  stomach  following  gastric 
ulcer.  He  points  out  that  50  per  cent,  of  cancers  of  the  pelvis  and  of  the 
kidney  were  demonstrably  superimposed  on  extensive  renal  calculi 
formation.  He  points  out  further  that  carcinoma  of  the  appendix 
usually  occurs  in  association  with  chronic  obliterative  processes,  and 
in  the  sigmoid  and  rectum,  the  irritation  in  diverticula  may  have  given 
rise  to  malignant  disease.  In  each  of  these  particular  phases  of  the  can- 
cer problem  further  research  would  seem  especially  desirable,  due  atten- 
tion being  given  to  elementary  principles  of  statistical  analysis. 

Cancer  and  Tuberculosis 

The  relation  of  cancer  to  certain  other  important  diseases  is  a  field 
of  research  which  as  yet  has  received  only  superficial  or  incidental  con- 
sideration. Foremost  among  the  diseases  related  to  cancerous  processes 
or  assumed  to  be  favorable  or  antagonistic  to  cancer  occurrence  are 
tuberculosis,  syphilis,  leprosy,*  gout,  rheumatism,  diabetes,  malaria  and 
appendicitis.  The  early  writers  on  the  cancer  problem  considered 
scrofula  as  a  primary  predisposing  cause,  but  during  the  nineteenth 
century  this  point  of  view  changed  to  the  opposite,  on  the  basis  of  the 
homeopathic  principle  in  medicine  that  two  dynamic  affections  can  not 
occur  at  the  same  time;  in  other  words,  the  less  persistent  disease  must 
yield  to  the  stronger.  This  view  was  shared  by  Hunter,  who,  according 
to  Wolff,  held  that  the  human  body  could  be  affected  by  only  a  single 
specific  disease  at  one  time.  These  conclusions  were  subsequently  set 
aside  by  the  evidence  of  coincident  diseases,  though,  of  course,  coexist- 
ing to  a  variable  degree  of  virulence.  Tuberculosis  and  cancer  may  occur 
in  the  same  person  at  the  same  time,  but  the  coincidence  is  apparently 
not  common.  This  coexistence  of  two  diseases  is  possible  not  only  in  the 
body  as  a  whole,  but  in  any  particular  organ  or  part.     The  main  factor 

*Per3onal  inquiry  at  the  Molokai  leper  settlement  has  failed  to  substantiate  the  view  that  there  is  a 
correlation  of  cancer  to  leprosy.  Leprosy  as  a  precancerous  condition  has  been  reported  by  Blaschko,  but 
apparently  the  conclusions  have  not  been  generally  accepted.  J.  W.  Vaughan  mentions  Guy  de  Chauliac 
(1300  A.  D.)  as  having  declared  that  cancer  was  closely  allied  to  leprosy,  but  no  evidence  in  support  of  this 
theory  has  been  produced-  The  age  and  sex  incidence  of  leprosy  follows  an  entirely  different  law  from  that  of 
cancer,  and  the  disease  is  most  common  among  indigenous  races,  who,  as  a  general  rule,  are  relatively  free  from 
malignant  disease.  ♦ 

187 


THE  MORTALITY  FROM  CANCER 

of  etiological  importance  in  connection  with  the  two  diseases  is  that 
tuberculosis  occurs  most  frequently  at  young  ages  and  cancer  at  ages 
over  45.  In  the  United  States  registration  area  in  the  year  1913,  out  of 
93,293  deaths  from  tuberculosis,  73.39  per  cent,  occurred  at  ages  under 
45,  and  26.61  per  cent,  at  ages  over  45.  Out  of  49,887  deaths  from  cancer 
at  all  ages,  15.46  per  cent,  occurred  at  ages  under  45,  and  84.54  percent., 
at  ages  over  45.  In  so  far  as  disease  is  a  function  of  age,  tuberculosis  and 
cancer  follow  apparently  opposite  laws  of  frequency  occurrence.  Among 
the  most  recent  statistical  studies,  according  to  Wolff,  are  the  data  of 
Goupil,  who  determined  a  proportion  of  9  per  cent,  of  tuberculosis  cases 
in  622  cases  of  cancer.  According  to  the  investigations  of  Cahen,  based 
upon  4,233  autopsies,  the  proportion  of  coincident  cases  of  cancer  and 
tuberculosis  was  only  5  per  cent.  Other  investigators  have  found  as  high 
as  20  per  cent.,  and  W.  R.  Williams  records  12.5  per  cent.  It  would  seem, 
however,  that  according  to  the  more  recent  investigations  the  combi- 
nation of  tuberculosis  and  carcinoma  is  much  less  than  according 
to  the  earlier  studies.  This,  in  part,  may  be  explained  by  the  diminish- 
ing frequency  of  tuberculosis  and  the  increasing  frequency  of  cancer. 
In  this  respect,  the  two  diseases  also  follow  apparently  opposite 
laws  of  frequency  occurrence.  The  mortality  from  tuberculosis  of  the 
lungs  in  American  cities  during  the  last  thirty  years  has  declined 
from  319.3  per  100,000  of  population  to  157.5,  or  50.7  per  cent.,  whereas 
the  cancer  death  rate  of  these  cities  during  the  same  period  of  time  has 
increased  from  46.9  to  85.4,  or  82.1  per  cent.  Much  the  same  tendency 
is  met  with  in  other  representative  civilized  countries. 

The  theory  of  antagonism  between  cancer  and  tuberculosis  was  first 
promulgated  by  Rokitansky.*  Summarizing  the  results  of  his  own 
investigations,  Rudolph  Schmidt,  in  his  treatise  on  "Tumors  of  the 
Abdominal  Viscera,"  observes  with  reference  to  the  theories  of  Roki- 
tansky that  "Individuals  with  well-developed  progressing  tuberculosis 
of  the  lungs  are  extremely  unlikely  to  have  carcinoma.  On  the  contrary, 
healed  apical  lesions  and  other  stationary  healed  tubercular  processes, 
or  such  as  incline  to  healing,  especially  those  of  glands  and  bones,  are 
decidedly  not  rare  in  cancerous  patients." 

Among  recent  studies  of  the  association  of  tuberculosis  and  malignant 
growth  a  reference  may  be  made  to  the  work  of  W.  H.  Harris  of  New 
Orleans.f  The  results  of  Harris's  investigations  are  briefly  summarized 
in  the  statement  that  "The  tuberculosis  formed  a  primary  pathologic 
soil  on  which  the  tumor  probably  thus  provoked  continued  to  flourish 
and  the  tuberculosis  in  part  yielded  to  the  cancerous  affection." 

Cancer  and  Syphilis 
The  possible  correlation  of  syphilis  to  cancer  has  also  not  been  accu- 
rately determined.    The  earliest  investigation,  as  stated  by  Wolff,  was  by 

*Journal  of  Medical  Research,  Boston,  1913. 

fThe  extreme  rarity  of  coincidence  in  cancer  and  tuberculosis  is  best  illustrated  in  the  actual  experience  of 
The  Henry  Phipps  Institute  of  Philadelphia.  From  the  opening  of  the  Institute  in  1903  to  January,  1915,  there 
have  been  633  autopsies  performed,  including  a  very  small  percentage  of  individuals  who  did  not  have  tubercu- 
losis. According  to  Dr.  H.  R.  M.  Landis,  Director  of  the  Clinical  and  Sociological  Departments,  "Of  the  entire 
number  there  was  but  one  instance  of  malignant  disease,  and  this  case  was  of  a  woman  who  at  the  autopsy  was 
found  to  have  a  number  of  nodules  in  the  lung,  which  had  had  their  origin  in  a  small  scirrhous  carcinoma  of  the 
left  breast.  This  woman  had  no  tuberculosis  whatever."  In  other  words,  in  the  experience  of  this  thoroughly 
representative  institution  there  have  been  no  cases  in  which  tuberculosis  and  malignant  disetfee  coexisted. 

188 


OBSERVATIONS  AND  CONCLUSIONS 

Leroy  d'Etiolles,  who  according  to  French  experience  held  that  out  of 
five  syphiHtics  one  would  be  afflicted  with  cancer.  The  importance  of 
considering  the  possible  coexistence  of  syphilis  and  cancer,  with  a  due 
regard  to  the  organ  or  part  of  the  body  affected  by  the  disease,  was  dis- 
cussed by  Poirier  in  1 907,  in  a  description  of  32  cases  of  cancer  of  the  tongue 
in  27  cases  of  which  syphilis  was  a  predisposing  or  precancerous  con- 
dition. Fabre,  as  early  as  1777,  attempted  to  prove  that  syphilis  was  an 
important  factor  in  cancer  causation,  and  since  that  time  many  writers 
have  contributed  the  results  of  their  observations  for  the  same  purpose. 
Horand  has  reemphasized  the  importance  of  considering  the  relation 
of  syphilis,  with  a  due  regard  to  the  site  of  the  cancerous  growth,  but 
no  evidence  has  apparently  been  produced  to  show  that  syphilis  must 
be  considered  a  specific  predisposition  to  cancer,  further  than  that  all 
imperfectly  healed  lesions  or  cicatrixes  are  liable  to  assume  a  malignant 
form  in  course  of  time.  Other  writers  on  the  subject  have  advanced 
opposite  conclusions,  including  W.  R.  Williams,  who  observes  that  in 
the  course  of  his  investigations  into  the  life-history  of  female  cancer 
patients  he  has  been  struck  by  the  extreme  rarity  with  which  signs  of 
syphilis  are  met  in  such  persons.  Thus,  out  of  325  female  cancer 
patients  consecutively  under  his  observation,  not  a  single  one  had  been 
addicted  to  prostitution,  so  far  as  he  was  able  to  ascertain;  and,  what 
was  more  remarkable,  only  a  single  one  presented  signs  of  having  had 
syphilis.  Moreover,  according  to  this  same  authority,  out  of  160  uterine- 
cancer  patients,  only  one  presented  signs  of  having  had  syphilis.  Other 
indications  furnished  by  a  careful  study  of  the  life-history  of  these  patients 
clearly  show  that  they  are  seldom  the  victims  of  syphilis.  He  therefore 
concludes  that  "The  victims  of  constitutional  syphilis  are  much  less 
prone  to  cancer  than  the  non-syphilitic.  And  this  comparative  im- 
munity of  the  syphilitic  is  probably  due  to  the  depraved  nutrition  and 
lowered  vitality,  caused  by  contamination  of  the  system  with  the 
syphilitic  virus," 

The  subject  is  referred  to  by  David  Heron  in  his  monograph  on 
"Extreme  Alcoholism  in  Adults."  The  investigations  by  Dr.  Branthwaite 
are  mentioned  as  raising  a  very  interesting  point  in  discussing  the  rela- 
tionship between  prostitution  and  cancer  of  the  mammary  and  genera- 
tive organs.  It  is  stated  by  Heron  that  "After  correcting  for  differences 
of  age  distribution,  we  find  that  71  per  cent,  of  the  cancer  among  inebri- 
ates affects  those  organs  while  in  the  general  population  the  proportion 
is  53  per  cent.  Among  inebriates  who  are  prostitutes  the  percentage 
rises  to  87.5  per  cent,  compared  with  52  per  cent,  in  the  general  popula- 
tion." It  is  admitted,  however,  that  the  numbers  are  small  and  do  not 
justify  further  analysis;  but  the  point  is  recognized  as  important  and, 
it  is  suggested,  should  be  tested  on  the  basis  of  more  adequate  statistical 
material.  Following  these  observations,  however,  it  is  pointed  out 
that  "None  of  those  prostitutes  who  had  cancer  are  marked  as  having 
had  syphilis  also,  but  it  is  not  quite  clear  from  the  report  whether  other 
and  less  severe  forms  of  disease  have  been  recorded  in  addition  to  the 
principal  disease."  Reference  is  made  to  the  conclusions  arrived  at  by 
Prof.  Rutherford  Morison  that  "Cancer  and  syphilis  are  very  firm 
allies  and  syphilis  often  provides  a  suitable  site  for  the  lodgment  of 

189 


THE  MORTALITY  FROM  CANCER 

cancer.  If  a  person  over  60  years  of  age  contracts  syphilis,  his  death 
from  cancer  may  be  anticipated."  Heron  also  refers  to  the  conclusions 
of  Dr.  F.  von  Esmarch  as  still  more  emphatic,  and  to  the  effect  that  in  his 
experience  during  recent  years  in  his  own  clinic  he  had  observed  in  cases 
of  sarcoma  that  more  than  one-half  of  the  patients  had  been  syphilitics, 
and  that  they  were  cured  through  antisyphiUtic  treatment.  It  is 
obvious  that  these  conclusions  rest  upon  inadequate  data,  subjected 
possibly  to  a  faulty  statistical  analysis.  The  cases  of  Von  Esmarch 
may  have  represented  an  exceptional  class  of  women,  for  there  is  no 
evidence  to  prove  that  syphilis  would  be  met  with  to  anything  like 
the  proportion  stated  by  him  in  the  ordinary  run  of  male  or  female 
patients  of  a  general  hospital  or  of  a  large  private  clinic.  The  subject  is 
one  well  deserving  of  further  study  and  research,  but  as  far  as  the  present 
available  evidence  permits  one  to  judge,  the  relation  of  syphilis  to 
cancer  is  only  remote.  This  view  is  sustained  by  the  observations  of 
Rudolph  Schmidt,  who  remarks  that  his  personal  impression  is  that  "So 
far  as  the  clinical  study  of  malignant  neoplasms  is  concerned,  luetic 
antecedents  are  not  frequent." 

Cancer  and  Rheumatism 

The  statistics  of  rheumatism  and  gout  in  their  relation  to  cancer 
are  fragmentary  and  inconclusive.  Recamier,  according  to  Wolff, 
considered  gout  a  predisposing  factor  in  cancer,  particularly  in  the  case 
of  women.  Bazin  as  early  as  1858  attempted  to  correlate  the  two 
diseases,  but  apparently  upon  an  inadequate  statistical  basis.  Beneke, 
in  1875,  and  Vigouroux,  as  recently  as  1906,  have  brought  forward 
evidence  in  support  of  this  contention.  According  to  the  last-named 
writer,  as  quoted  by  Wolff,  cancer  and  arthritis  are  closely  related;  in 
fact,  he  goes  so  far  as  to  maintain  that  the  majority  of  cancer  patients 
suffer  from  some  form  of  arthritis,  the  fact,  apparently  not  being  given 
due  consideration,  that  rheumatic  afflictions  are  as  such  largely  inci- 
dental to  advanced  age.  The  term  arthritism  as  used  by  these  writers 
is  quite  comprehensive,  and  apparently  includes  such  widely  different 
diseases  as  gall-stones,  dyspepsia,  diabetes,  heart  diseases,  etc.  Neither 
statistical  nor  clinical  evidence  has  been  brought  forward  in  adequate 
support  of  this  important  contention. 

'  In  a  discussion  on  "Cancer  in  New  Zealand,"  Hislop  and  Fenwick* 
observed,  with  particular  references  to  cancer-houses,  that  "So  many  of 
the  cases  were  rheumatic,  and  rheumatism  was  so  -prevalent  iii  subacute 
or  chronic  forms  in  hush  districts,  that  tve  can  hardly  ascribe  the  coin- 
cidence of  rheumatism  and  cancer  to  an  accident."  They  add  the  rather 
suggestive  observation  that  "It  is  not  impossible  to  imagine  that  the 
circulation  of  the  blood  in  rheumatic  cases  may  act  as  a  direct  irritant 
to  tissues."  It  may  be  said  in  this  connection  that  dampness  has 
frequently  been  alleged  to  be  a  contributory  cause  in  excessive  cancer 
frequency,  and  the  theory  has  been  advanced  that  well-wooded  countries 
are  almost  constantly  the  areas  of  high  cancer  mortality,  and  that 
isolated  houses  surrounded  by  trees  especially  harbor  the  disease. 
Childe,  in  his  treatise  on  "The  Control  of  a  Scourge,"  draws  attention 

'BritM  Medical  Journal,  October  23, 1909. 

190 


OBSERVATIONS  AND  CONCLUSIONS 

to  the  close  connection  of  "low-lying  districts  and  trees  as  a  cause  of 
cancer,"  but  he  remarks  that  the  contributory  cause  was  more  likely 
dampness,  and  he  quotes  the  results  of  an  analysis  of  100  cases  of 
cancer  of  the  breast,  in  which  30  per  cent,  showed  a  well-marked  history 
of  exposure  to  dampness  in  some  form  or  other,  and  he  makes  the  rather 
unpractical  suggestion  that  "Women  should  not  reside  in  places  with 
a  damp  climate,  or  where  mists  and  fogs  prevail." 

The  relation  of  rheumatism  to  dampness  is  too  well  established  to 
require  explanation.  Dampness  as  a  contributory  cause  in  rheumatism 
may,  therefore,  occur  as  a  mere  matter  of  coincidence  in  a  relatively  large 
number  of  cancer  cases.  In  his  classical  treatise  on  the  "Geography  of 
Heart  Disease,  Cancer  and  Phthisis,"  Haviland  drew  attention  to  the 
coincidence  of  an  excess  in  cancer  frequency  in  the  sections  of  England 
more  or  less  subject  to  periodical  inundation,  and  a  consequential 
resulting  dampness.  He  laid  down  the  important  principle  that  "Can- 
cer does  not  thrive  on  high,  dry  soil,"  and  furthermore,  that  the  facts 
prove  that  "Rheumatism  is  the  forerunner  of  the  great  mass  of  heart 
disease,"  and  that  in  cancer,  "The  high,  dry  sites  on  the  older  rocks  are 
the  places  where  cancer  does  not  thrive,  and  that  it  does  thrive  in  the 
vales  by  the  sides  of  large  rivers  which  overflow  their  banks,  and  in  the 
neighborhood  of  which  are  to  be  found  the  drifts  of  ages  of  washings  from 
the  inhabited  country  above."  No  exhaustive  statistical  investigations 
have  been  made  to  establish  with  a  reasonable  degree  of  scientific  con- 
clusiveness the  coincidence  of  cancer  and  rheumatism  in  low-lying,  damp, 
ill-drained  sections  of  the  country  subject  to  a  heavy  rainfall,  in  contrast 
to  high-lying,  well-drained  and  semiarid  regions.  Much  general  in- 
formation is  available,  however,  to  prove  that  cancer  in  the  former 
regions  is  more  common  than  in  the  latter.* 

Cancer  and  Gout 

Gout,  as  perhaps  the  best  illustration  of  malnutrition,  may  by  in- 
ference be  considered  a  precancerous  symptom.  But  what  is  true  of 
gout  is  equally  true  of  cancer;  as  observed  by  Von  Noorden,  in  his  treatise 
on  "The  Pathology  of  Metabolism,"  "The  leading  scientific  investigators 
have  devoted  their  best  efforts  to  the  solving  of  the  questions  dealing 
with  the  theory  of  gout,  yet  our  knowledge  concerning  its  metabolic 
processes  stands  in  marked  contrast  to  the  amount  of  thought  expended 
upon  the  elaboration  of  its  theory."  The  anomalies  of  the  metabolism 
of  gout,  especially  with  reference  to  uric  acid,  may  possibly  be  found  to 
correspond  to  similar  conditions  in  cancer.  It  is  significant,  however, 
that  in  England,  where  in  the  past  gout  has  been  most  common,  the  mor- 
tality from  this  cause  should  have  been  on  the  decrease  during  years  in 
which  in  contrast  there  was  a  marked  rise  in  the  mortality  from  cancer. 
The  death  rate  from  gout  among  males  in  England  and  Wales  has  declined 
from  3.7  per  100,000  in  1891  to  1 .8  in  1910.  The  combined  death  rate  from 
all  forms  of  rheumatism,  including  rheumatic  gout,  has  declined  from  12.6 
per  100,000  in  1891  to  7.9  in  1910.  In  contrast,  the  mortality  from  all 
forms  of  cancer,  including  sarcoma,  has  increased  during  the  same  period 
from  51.8  per  100,000  to  85.7.     It  is  remotely  possible,  of  course,  that 

*See  also  the  discussion  under  topography,  on  page  196. 

191 
14 


TEE  MORTALITY  FROM  CANCER 

there  has  been  a  transference  of  cancer  cases  formerly  classified  under 
gout  or  rheumatic  affections  to  the  cancer  group,  but  the  evidence  is  quite 
conclusive,  as  a  matter  of  general  observation,  that  the  typical  form  of 
gout  so  common  in  England  30  years  ago  is  relatively  less  frequent  at  the 
present  time.  In  15  cases  of  applicants  with  a  record  of  gout  in  their 
personal  history  in  the  experience  of  the  Mutual  Life  Insurance  Company, 
%  died  from  gout;  4,  from  heart  disease;  1,  from  Bright's  disease;  2,  from 
dropsy;  1,  from  apoplexy ;  4,  from  acute  rheumatism;  and  1,  from  tumor  of 
the  liver,  but  whether  malignant  or  not  is  not  stated.  The  evidence  in 
this  case  would,  therefore,  have  to  be  considered  negative.  The  same 
conclusion  applies  to  most  of  the  available  data  regarding  the  possible 
relation  of  cancer  to  gout  and  other  rheumatic  affections.  As  yet, 
however,  no  thorough  study  has  been  made  of  the  comparative  frequency 
of  cancer  and  rheumatic  affections  in  typical  semiarid  and  humid 
localities,  with  a  due  regard,  of  course,  to  the  organs  and  parts  of  the 
body  affected  by  malignant  disease. 

Cancer  and  Diabetes 

There  is  also  apparently  a  well-defined  correlation  between  diabetes 
and  cancer.  The  conditions  responsible  for  nutritional  disturbances 
may  possibly  be  in  part  the  same  in  both  diseases.  One  of  the  con- 
tributory factors  of  considerable  importance  in  diabetes  is  unrestricted 
"eating  and  drinking,"  or,  in  other  words,  overnutrition.  Diabetes  is 
usually  rather  frequent  in  the  Hebrew  race,  but  this  is  apparently 
not  the  case  with  cancer.  "The  pathogenesis  of  the  disease,"  according 
to  Savill,  "is  not  at  present  known,"  but  it  is  certain  that  the  pancreas 
is  fibrotic  in  about  50  per  cent.  He  adds  that  physiological  evidence 
points  in  this  direction,  and  that  the  glycogenic  function  of  the  liver 
is  in  some  way  interfered  with,  possibly  indirectly  through  the  pancreas. 
The  disease  occurs  chiefly  among  the  well-to-do,  and  in  the  proportion 
of  three  males  to  two  females.  According  to  Gould  and  Pyle,  "occasion- 
ally there  are  lesions  of  the  pancreas,  but  usually  no  anatomic  lesion 
can  be  found."  The  complications  of  diabetes  are  numerous,  but  they 
apparently  do  not  often  include  cancer.  The  chief  treatment  is  dietetic, 
and  consists  in  the  reduction  of  sugars  and  farinaceous  foods.  No  such 
treatment,  apparently,  would  be  of  much  value,  if  any,  in  cancer.  A 
high  correlation  between  the  death  rate  from  cancer  and  diabetes  was 
brought  out  in  a  statistical  study  by  Dr.  G.  D.  Maynard,  of  Johannes- 
burg, South  Africa.*  The  evidence,  however,  can  not  be  considered 
entirely  conclusive.     W.  R.  Williams  remarks  in  this  connection  that 

*The  original  paper  by  Maynard  was  published  in  Biometrika  for  April,  1910.  Among  the  conclusions 
advanced  are  the  following: 

1.  That  recorded  differences  in  cancer  and  diabetes  death-rates,  as  applying  to  different  districts  and  cities 
of  the  U.  S.  A.,  as  well  as  the  increased  rates  observed  in  recent  years,  do  indicate  real  differences  in  the  preva- 
lence of  the  disease. 

2.  The  correlations  found  to  exist  between  cancer,  diabetes  and  insanity  are  not  fortuitous  and  due  merely 
to  errors  of  observation  or  record. 

3.  The  statistics  dealt  with  in  this  paper  do  not  give  any  support  to  the  suggestion  that  cancer  is  of  infectious 
origin. 

4.  That  whatever  theory  as  to  the  causation  of  cancer  is  adopted,  some  explanation  of  the  remarkable  cor- 
relations between  cancer,  diabetes  and  insanity  is  required. 

6.  The  explanation  suggested  to  account  for  the  facts  as  disclosed  by  statistical  analysis  is  that  conditions 
of  modern  life,  acting  on  physiologically  unsound  material,  may  account  for  the  correlations  existing  between 
these  three  diseases,  as  well  as  for  their  increasing  rates. 

192 


OBSERVATIONS  AND  CONCLUSIONS 

it  is  interesting  to  note  that  "Of  late  many  instances  of  the  association 
of  malignant  tumors  with  diabetes  have  been  reported,  and  most  of  those 
who  have  specially  studied  the  subject  maintain  that  the  diabetic  state 
favors  the  development  of  malignant  disease."  He  points  out  that  it  is 
well  known  that  malignant  tumors  "are  rich  in  glycogen,  and  that  the 
blood  of  those  who  bear  these  tumors  contains  an  excess  of  sugar-forming 
substances."  In  his  own  experience,  however,  Dr,  Williams  noticed 
the  diabetic  state  in  only  a  few  of  his  numerous  cancer  patients,  and  he 
remarks  that  other  pathologists  have  also  called  attention  to  the  rarity 
of  this  conjunction,  "even  when  the  pancreas  is  the  seat  of  malignant 
disease,  diabetes  is  far  from  common."  The  statistical  evidence  is  very 
limited,  but  reference  may  be  made  to  Boas,  a  German  observer,  who 
reports  that  of  366  patients  with  intestinal  cancer,  12,  or  3.3  per  cent., 
were  also  affected  with  diabetes.  WiUiams  quotes  62  cases  collected 
by  Kappeler,  according  to  whose  investigations  the  seats  of  the  can- 
cerous disease  complicated  by  diabetes  were  as  follows:  breast,  18; 
mouth,  12;  stomach  and  liver,  12;  uterus,  3;  rectum,  2;  colon  and  ovary 
each  in  1  case.  The  same  writer  quotes  Frerichs  regarding  the  cause 
of  death  in  200  diabetic  patients,  of  whom  only  6,  or  3.0  per  cent.,  died 
of  cancer.  Gilford,*  in  his  discussion  of  diabetes  and  its  association  with 
acromegaly,  liver  cirrhosis,  obesity  and  senilism,  makes  no  reference 
to  cancer.  The  evidence,  therefore,  as  far  as  available,  would  seem  to 
indicate  that  the  actual  correlation  of  cancer  to  diabetes  is  comparatively 
slight. 

In  contrast  to  the  absence  of  conclusive  evidence  of  such  correlation, 
the  increase  in  the  mortality  from  diabetes  in  civilized  countries  cor- 
responding, more  or  less,  to  the  increase  in  cancer  frequency,  is  of  con- 
siderable interest,  at  least  as  a  problem  in  statistics.!  In  England  and 
Wales  during  the  period  1900-12,  the  cancer  death  rate  increased  from 
82.9  per  100,000  to  102.2,  or  23  per  cent.,  whereas  the  diabetes  death  rate 
increased  from  8.6  to  11.1,  or  29  per  cent.  In  ten  registration  states 
of  the  United  States  during  the  period  1900-12,  the  cancer  death  rate 
increased  from  63.8  to  85.3,  or  34  per  cent.,  whereas  the  diabetes 
death  rate  increased  from  11.0  to  17.6,  or  60.0  per  cent.  Since  diabetes 
is  much  more  common  among  Jews  than  Gentiles,  the  material  increase 
in  the  diabetes  mortality  in  the  ten  states  referred  to  is,  no  doubt,  due  in 
part,  to  the  large  Hebrew  immigration  during  recent  years.  That  this, 
however,  can  not  be  the  only  explanation,  if  it  is  any  explanation  at  all, 
is  shown  by  the  statistics  for  Norway.     In  that  country  the  cancer 

*Hasting3  Gilford,  "The  Disorders  of  Post-Natal  Growth  and  Development,"  London,  1911. 

fThe  following  comparative  cancer  and  diabetes  mortality  rates  are  derived  from  official  sources  for  the 
period  1908-12: 

Mortality  from  Cancer  and  Diabetes 
1908-1912 


Deaths 

United  States  of  America  (16  States) 150,750 

England  and  Wales   174,602 

Norway 11,461 

Australia 16,096 


Canceb 

Diabetes 

Rate  per 

100,000 

Population 

Deaths 

Rate  per 

100,000 

Population 

76.3 

30,047 

15.2 

97.6 

19,149 

10.7 

97.4 

865 

7.2 

73.2 

2,006 

9.1 

193 


THE  MORTALITY  FROM  CANCER 

death  rate  increased  from  90.8  to  104.8,  whereas  the  diabetes  death  rate 
increased  from  5.1  to  8.0.  Cancer  increased  15  per  cent.,  against  an 
increase  of  57  per  cent,  in  the  mortahty  from  diabetes.  Still  more  sug- 
gestive are  the  changes  in  the  cancer  and  diabetes  death  rates  of  the 
Commonwealth  of  Austraha  (1900-12).  Cancer  increased  from  62.6 
to  76.1,  or  22  per  cent.,  whereas  diabetes  increased  from  4.2  to  10.1, 
or  140  per  cent.  The  evidence,  while  inconclusive  regarding  a  possible 
relation  of  cancer  to  diabetes,  or  vice  versa,  is  of  exceptional  interest  in 
view  of  the  recognized  underlying  serious  nutritional  disturbances 
in  both  diseases. 

Cancer  and  Appendicitis 
The  possible  relation  of  cancer  to  appendicitis  has  been  a  matter  of 
much  interest  for  many  years  to  students  of  the  cancer  problem.  Howard 
A.  Kelly,  in  his  treatise  on  "Appendicitis  and  Other  Diseases  of  the 
Vermiform  Appendix,"  calls  attention  to  the  fact  that  "The  number  of 
cases  recorded  of  primary  tumors  in  the  vermiform  appendix  is  small, 
but  during  the  past  few  years,  since  the  operative  treatment  of  right  iliac 
disease  and  careful  routine,  laboratory  examination  of  the  removed 
organs  has  become  general,  it  has  been  found  that  they  are  by  no  means 
so  rare  as  formerly  supposed."  He  also  remarks  that  since  1898  "a 
considerable  number  of  cases  of  malignant  neoplasm  limited  to  the 
appendix  have  been  carefully  described,  while  secondary  involvement 
of  the  organ  is. comparatively  common."  According  to  the  same  au- 
thority, however,  it  would  appear  that  benign  tumors  are  extremely  rare. 
The  investigations  by  Maydl  and  Nothnagel,  concerning  the  occurrence 
of  primary  carcinoma  of  the  appendix,  as  shown  by  autopsy  records,  are 
referred  to,  it  being  stated  that  out  of  40,738  autopsies  made  at  the 
Vienna  General  Hospital  during  the  twenty-two  years,  1870-92,  only 
two  cases  of  carcinoma  of  the  appendix  out  of  343  instances  of  cancer  of 
the  digestive  tract  were  found.  During  recent  years  the  evidence  from 
numerous  sources  has  been  rapidly  accumulating,  tending  to  show  in  the 
words  of  Dr.  Kelly,  that  "Primary  carcinoma  of  the  appendix  is  not 
such  an  uncommon  disease  as  has  hitherto  been  supposed  to  be  the  case." 
"Mechanical  irritation,"  he  remarks,  "appears  to  play  an  unimportant 
role  in  the  development  of  tumors  of  the  appendix."  He  points  out, 
however,  that  "Considering  the  frequent  occurrence  of  carcinoma 
following  stones  in  the  gall-bladder  and  bile-ducts,  it  is  surprising  how 
few  cases  occur  similarly  in  the  appendix."  He  refers  to  the  ages  at 
which  maHgnant  tumors  of  the  appendix  develop,  it  being  shown  that  the 
large  majority  occur  between  the  tenth  and  the  fortieth  year,  or  to  be 
specific,  out  of  69  patients  58,  or  86  per  cent.,  occurred  during  this  period 
of  life.  It  is,  of  course,  well  known  that  the  average  age  at  death  in 
appendicitis  is  much  lower  than  in  malignant  disease,  and  the  age  dis- 
tribution of  deaths  follows  a  distinctly  different  curve  in  appendicitis 
than  in  carcinoma.  According  to  Rudolph  Schmidt,  the  diagnosis  of 
malignant  tumors  of  the  appendix  is  difficult  on  account  of  their  small 
size,  for  apparently  "they  do  not  lead  to  metastases  and  do  not  show 
unlimited  growth."  He  therefore  concludes  that  such  tumors  can  hardly 
be  looked  upon  as  "malignant"  in  a  clinical  sense,  even  though  they 
bear  their  histological  characteristics.     Dr.  John  A.  Lichty  of  Pittsburgh, 

194 


OBSERVATIONS  AND  CONCLUSIONS 

In  a  discussion  of  the  pathological  relation  of  ulcer  to  carcinoma  of 
the  alimentary  canal,*  calls  attention  to  the  fact  that  in  only  20  out  of 
5,000  cases  of  appendicitis  was  malignancy  established.  Mayo  in  an 
address  on  "The  Prophylaxis  of  Cancer,"t  refers  to  the  investigation  by 
MacCarthy  showing  that  out  of  5,000  removed  appendices  for  so-called 
chronic  subacute  appendicitis,  only  0.5  per  cent,  were  carcinomatous, 
although  the  external  appearance  of  these  appendices  did  not  always 
indicate  such  a  condition.  The  subject  was  quite  fully  discussed  in 
an  editorial  in  the  Journal  of  the  American  Medical  Association,  January 
14,  1911,  in  which  the  results  of  a  careful  study  are  summarized  in  the 
statement  that  "Statistics  from  large  clinics,  where  great  numbers  of 
appendices  are  removed  and  thoroughly  examined,  have  shown  with 
remarkable  uniformity  that  not  far  from  0.5  per  cent,  of  all  appendices 
removed  for  all  causes  show  thickenings,  nodules  or  tumor  masses  which 
exhibit  a  microscopic  structure  warranting  the  pathologist  in  returning  a 
diagnosis  of  cancer. ' '  It  is  observed,  however,  in  this  connection  that ' 'Of 
late  there  has  been  a  growing  doubt  as  to  whether,  after  all,  these  epithe- 
lial neoplasms  in  the  appendix  are  true  cancers,  in  spite  of  the  typical 
invasion  of  the  connective  and  muscular  tissues  by  strands  of  columnar 
or  spheroidal  cells."  Reference  is  made  to  a  discussion  at  a  meeting  of  the 
German  Pathological  Society  in  1910,  at  which  Winkler  reported  that 
he  had  "found  at  autopsies  no  less  than  six  appendices  showing  changes 
of  the  type  usually  diagnosed  as  carcinoma,  yet  in  none  of  these  cases  was 
there  evident  regional  infiltration  or  local  or  remote  metastases."  The 
subject  has  also  been  discussed  at  a  comparatively  recent  meeting  of  the 
Edinburgh  Medico-Chirurgical  Society,  at  which  the  new  evidence 
presented  was  largely  in  the  negative,  and  this  may  be  summarized  in  the 
brief  statement  that  "Cancer  of  the  appendix,  especially  in  spheroidal- 
celled  cases,  must  be  of  a  naturally  benign  type,  comparable  to  rodent 
ulcer,  locally  invading  but  rarely  giving  rise  to  metastases." 

Parasitic  Theory  of  Cancer  Causation 
All  studies  of  cancer  frequency  in  correlation  to  other  diseases  are  of 
value  as  contributions  to  the  theory  of  the  origin  of  cancer,  or  the  cause 
or  contributory  conditions  primarily  accountable  for  the  disease.  The 
wide  distribution  of  cancer  among  civilized  races,  and  particularly  in 
well-settled  communities  or  districts,  early  directed  attention  to  the 
possibility  of  its  being  an  infectious  or  contagious  affliction  of  mankind. 
Countless  papers  have  been  contributed  to  the  parasitic  theory  of  cancer, 
but  in  the  main  the  conclusions  of  even  the  foremost  authorities  on  the 
subject  must  be  considered  unconvincing.  The  entire  question  of  cancer 
as  a  contagious  disease,  its  direct  or  indirect  transmission  from  person  to 
person,  the  extremely  complex  question  of  cancer  a  deux,  J  has  been 
exhaustively  dealt  with  by  Wolff  in  the  first  volume  of  his  treatise  on 
cancer.  Many  citations  are  given  of  observations  based  largely  on 
individual  cases,  tending  to  prove  the  parasitical  theory,  but  in  the  main 
the  data  must  be  considered  inconclusive.  The  statistical  evidence 
in  support  of  the  theory,  particularly  in  regard  to  the  so-called  cancer- 
houses,  cancer-streets  and  cancer-villages,  is  also  largely  in  the  negative. 

*Joumal  of  the  American  Medical  Association,  September  10,  1910. 

\J(mTnal  of  the  American  Medical  Association,  November  5,  1910. 

ti.  Wolff,  Die  Lehre  von  der  Krebskrankheit.  Jena,  1907,  Vol.  i,  pp.  519-710. 

195 


TEE  MORTALITY  FROM  CANCER 

Charles  P.  Childe  directs  attention  to  the  likeness  of  morbid  new- 
growths  in  human  beings  to  some  of  the  large  parasitic  tumors  of 
plants  and  trees  as  tending  to  encourage  the  belief  in  the  parasitic 
origin  of  cancer,  but  he  considers  most  of  these  as  wholly  fantastical. 
He  points  out  that  "Pathologists  all  the  world  over  have  been  hunting 
for  the  parasite,  and  so  many  parasites  have  been  found,  and  no  sooner 
found  than  found  wanting,  that  a  sense  of  disappointment  has  resulted, 
a  sort  of  natural  reaction  has  set  in  against  this  explanation  of  the  origin  of 
cancer."  He,  however,  accepts  the  parasitic  theory  as  perhaps  better 
than  any  other  in  explaining  some  of  its  phenomena,  but  the  evidence 
he  advances  is  quite  inconclusive.  Charles  Powell  White,  in  his  treatise 
on  "The  Pathology  of  Growth,"  holds  that  the  increased  proliferative 
capacity  of  the  cells  can  not  be  ascribed  to  specific  parasites,  and  that  "It 
does  not  seem  possible  in  any  other  way  to  explain  tumor  growths 
by  the  assumption  of  a  specific  causal  parasite."  According  to  this 
exceptionally  careful  observer,  "It  is  impossible  to  account  for  the 
histiomata  on  this  basis,  and  it  is  equally  impossible  to  explain  the  com- 
plicated tumors,  such  as  blastocytomata,  teratomata  and  compound 
sarcomata."  There  only  remain,  therefore,  "the  sarcomata  and  car- 
cinomata,  and  even  in  these  cases  the  assumption  of  a  specific  parasitic 
origin  leads  to  numerous  difficulties."  He  enumerates  three  possibilities, 
as  follows: 

(a)  There  may  be  a  single  parasite  for  sarcoma  and  carcinoma.  In  this  case  it  is 
impossible  to  explain  the  regularity  with  which  metastatic  tumors  repeat  the  structure 
of  the  primary.  We  never  find  a  primary  carcinoma  giving  rise  to  secondary  sarcomatous 
tumors  as  we  should  expect  if  both  were  due  to  the  same  causal  parasite. 

(6)  There  may  be  one  parasite  for  sarcoma  and  another  for  carcinoma.  Here  again 
the  similarity  of  the  metastatic  tumors  to  the  primary  provides  an  insuperable  difficulty. 
If  all  forms  of  carcinoma  were  due  to  a  single  parasite  we  should  expect  that  metastases 
in  the  liver,  in  some  cases  at  least,  would  show  the  type  of  hepatic  carcinoma:  this  does 
not  occur. 

(c)  Each  form  of  sarcoma  and  carcinoma  may  have  its  own  specific  parasite.  Here 
we  are  at  once  met  with  the  difficulty  that  the  different  forms  of  these  tumors  are  almost 
innumerable,  corresponding  to  the  innumerable  kinds  of  cells  in  the  body.  While  they 
may  be  reduced  to  a  limited  number  of  type  forms,  yet  there  is  no  sharp  boimdary  between 
the  different  groups,  and  there  is  a  considerable  variation  within  the  limits  of  each  group. 
We  should  have  to  suppose  a  different  set  of  cancer  parasites  for  each  organ,  and  not 
only  this,  but  we  should  have  to  assume  a  different  series  of  parasites  for  each  species  of 
animal!  The  fact  that  tumors  are  found  in  all  genera  of  the  higher  animals  and  have  the 
same  characters  throughout,  and  yet  it  is  impossible  to  graft  a  tumor  from  an  animal 
of  one  species  into  another  animal  of  a  different  species,  while  it  is  possible  to  do  so 
within  the  same  species,  tells  strongly  against  the  theory  of  a  parasitic  origin. 

Upon  the  basis  of  the  foregoing  observations  he  concludes  that  the 
assumption  of  a  specific  parasitic  explanation  leads  to  insuperable 
difficulties  in  explaining  the  observed  phenomena.  He  adds,  however, 
"These  difficulties  entirely  disappear  if  we  consider  the  cancer  cell 
itself  as  a  parasite  and  cancer  as  a  process  of  infection  by  cancer  cells." 
This  conclusion,  however,  has  not  been  generally  accepted. 

Topography  and  Cancer  Occurrence 

Frequent  attempts  have  been  made  at  precise  correlation  of  local 
topography  to  exceptional  cancer  frequency,  particularly  in  support  of 
the  parasitic  theory  of  cancer  origin.     So-called  cancer  houses,  alleys, 

196 


OBSERl/iTIONS  AND  CONCLUSIONS 

streets  and  villages  are  occasionally  referred  to  in  the  literature  of  the 
subject,  and  in  some  cases  the  evidence,  if  not  conclusive,  is  certainly  not 
far  from  convincing  that  exceptional  contributory  conditions  may  exist, 
the  nature  of  which  has  not  yet  been  disclosed  by  the  most  scientific 
methods  of  research.  Behla,  in  numerous  contributions  to  German 
medical  literature  and  the  publications  of  the  Imperial  Health  Depart- 
ment, has  brought  forward  evidence  to  prove  that  a  low-lying,  swampy 
area  favors  an  excessive  frequency  of  cancer  occurrence.  At  Luckau,  for 
illustration,  Behla  found  that  in  the  low-lying  suburban  section  cancer 
was  nine  times  more  common  than  in  the  higher  or  more  elevated  portions 
of  the  city.  The  suburban  section  was  surrounded  by  much  stagnant 
water,  which,  it  is  implied,  acted  as  a  medium  for  the  conveyance  of  cancer 
parasites.  The  investigations  of  Behla  are  largely  relied  upon  in  support 
of  the  theory  of  cancer  causation  advanced  by  Green,  who  quotes  from 
Murphy's  Surgery  an  interesting  reference  to  a  cancer  district  in  which  it 
is  claimed  that  cancer  was  exceptionally  frequent  in  corner  houses.  On 
the  basis  of  a  survey  as  part  of  a  special  study  of  conditions  in  Scotland, 
Green  concluded  that  the  cancer  death  rate  was  invariably  excessive  in 
towns  lying  in  a  hollow,  moderately  high  in  towns  on  distinctly  steep  or 
hilly  sites,  and  invariably  below  the  average  in  towns  on  slopes  and  sites 
with  comparatively  flat  surroundings.  The  highest  death  rate  given  by 
Green,  7.02,  is  for  the  town  of  Forfar,  described  as  a  town  200  feet 
above  sea-level  in  a  kind  of  basin  formed  by  the  surrounding  slopes.  Other 
towns  with  high  death  rates  are  referred  to  as  located  in  a  basin,  or  sur- 
rounded on  all  sides,  or  hemmed  in  by  rising  ground,  or  overlooked  by  an 
amphitheater  of  well-wooded  hills,  etc.  The  lowest  rate  given  by  Green, 
1.75,  is  for  the  town  of  Kirkintilloch,  described  as  being  located  in 
a  low  flat  plain ;  and  other  towns  with  low  rates  are  referred  to  as  being  sur- 
rounded by  a  wide  tract  of  flat  country,  or  nowhere  more  than  a  few  feet 
above  the  level  of  the  spring  tides.  The  difiiculty  with  investigations  of 
this  kind  is  that  the  influence  of  topography  is  most  likely  to  be  obscured 
by  other  factors  of  equal,  or  even  more  pronounced,  influence  in  causing 
variations  in  the  cancer  death  rate.  A  precisecorrelation  of  such  conditions 
to  the  growth  and  dissemination  of  a  specific  parasite  fails  invariably  on 
the  ground  that  the  common  occurrence  of  cancer  under  fundamentally 
different  conditions  remains  inexplicable.  The  theory  advanced  by 
Green  is  that  the  special  statistics  collected  by  him,  with,  it  requires  to  be 
said,  unusual  caution  and  care,  "prove  that  it  must  be  some  element  in 
the  environment  of  the  sufferer  which  induces  the  disease,  and  if  we  ad- 
mit this,  we  must  admit  an  extrinsic  origin."  This  conclusion  does  not 
necessarily  follow;  nor  is  this  view  at  the  present  time  accepted  by  any 
one  of  the  leading  authorities  in  the  world  on  cancer  causation.  The 
view  of  Green,  that  "the  longer  one  considers  the  question  the  stronger 
the  presumption  becomes  that  the  cause  is  biochemical  or  parasitic" 
has,  no  doubt,  some  general  evidence  in  its  favor,  but  unfortunately  the 
proof  advanced  has  not  stood  the  test  of  subsequent  investigations, 
although  it  does  not  by  any  means  follow  that  the  parasitical  nature  of 
the  disease  may  not  be  established  in  course  of  time.  It  is  conceivable 
that  with  the  further  advance  of  biology,and  particularly  the  minute  study 
of  animal  and  vegetable  parasites,  a  micro-organism  may  be  discovered 

197 


THE  MORTALITY  FROM  CANCER 

which  conforms  neither  to  the  one  nor  to  the  other,  though  having 
in  common  some  of  the  functions  of  each.  It  is  also  quite  conceivable, 
in  fact  fairly  well-established,  that  of  the  three  distinct  groups  of  plant 
parasites,  as  classified  by  Delafield  and  Prudden,  "1,  Bacteria,  or  fission 
fungi  (Schizomycetes),  2,  Yeasts,  or  yeast  fungi,  or  sprouting  fungi 
(Blastomycetes),  3,  Moulds,  or  mould  fungi  (Hyphomycetes),"  the 
second  group,  under  given  conditions,  may  assume  characteristics  or 
perform  functions  quite  at  variance  with  the  first  and  with  the  last.  The 
bacteria  are,  as  is  well  known,  of  the  greatest  importance,  because  of  the 
fact  that  they  are  very  frequently  the  immediate  causative  factors  in 
serious  disease,  the  course  of  which  differs  fundamentally  and  in  all 
essentials  from  the  clinical  pathology  of  cancer.  The  micro-organisms 
of  the  second  group  are  larger  than  bacteria,  and  they  are  the  direct 
causative  factor  in  blastomycotic  dermatitis,  which  is  described  as  "a 
localized  inflammation,  papular  and  pustular  in  character,  leading 
to  warty  outgrowths,  to  the  formation  of  abscesses  beneath  the  skin, 
and  to  ulcers."  A  generalization  of  the  blastomycotic  infection,  under 
given  conditions,  may  prove  fatal.  According  to  Delafield  and  Prudden, 
there  are  several  forms  of  blastomycetes,  but  their  classification  is  un- 
satisfactory. These  references  to  biological  consideration  are  sufficient 
to  illustrate  the  very  complex  and  ultrascientific  character  of  the 
possible  underlying  and  as  yet  undiscovered  specific  causative  factors 
responsible  for  malignant  tumor  formation.  The  hypothesis,  therefore, 
that  cancer  may  be  caused  by  micro-organisms  entering  the  system  from 
without  is  by  no  means  unsupported  by  evidence  entitled  to  scientific 
consideration.  The  difficulty  lies  in  the  practical  application  of  the 
knowledge  at  present  available  to  so  extremely  involved,  widely  varying, 
and  apparently  ever-illusive  a  problem  as  a  high  or  a  low  degree  of 
cancer  frequency  under  apparently  more  or  less  identical  external  con- 
ditions. 

Cancer-Houses 

The  practical  importance  of  these  studies  lies  in  their  application  to 
the  theory  of  cancer  infection  through  some  medium  of  contagion  as 
yet  undiscovered,  but  apparently  met  with  in  an  exceptional  degree  of 
virulence  in  certain  areas  described  as  cancer-villages,  cancer-streets, 
cancer-houses,  and  even  cancer-rooms.  Green  cites  such  a  house  in 
the  third  edition  of  his  statistical  study  of  the  cancer  problem,  which  was 
located  in  his  own  district,  and  "which  had  ultimately  to  be  pulled  down 
owing  to  the  great  number  of  deaths  from  cancer  which  occurred  in 
it."  Wolff,  in  the  third  volume  of  his  treatise  on  cancer,  reviews  the 
literature  of  the  controversy,  which  has  recently  been  revived  by  an 
extended  discussion  by  Sir  Thomas  Oliver,  of  Newcastle-on-Tyne,  and 
a  counter  statement  by  the  Director  of  the  Imperial  Cancer  Research 
Fund,  in  the  Twelfth  Annual  Report  of  the  Fund,  issued  under  date  of 
July  21,  1914.  In  brief,  it  would  appear  that  the  large  majority  of  so- 
called  cancer-houses  were  old,  mouldy,  damp,  badly  ventilated  and  other- 
wise unsanitary.  Norwegian  observers  have  called  attention  to  the 
exceptional  frequency  of  cancer  in  old  farmhouses,  and  similar  reports 
have  been  made  for  certain  sections  of  Germany,  including  references 
to  old  rectories  occupied  by  the  clergy.     In  all  such  cases  it  is  obvious 

198 


OBSERVATIONS  AND  CONCLUSIONS 

that  there  would  be,  at  least  as  a  matter  of  frequent  coincidence,  a  pre- 
ponderance of  aged  persons  of  the  cancer  period  living  in  the  houses 
referred  to.  Old,  dilapidated,  damp  and  neglected  houses  are  usually 
the  refuge  of  the  aged  poor,  unwilling  to  go  to  almshouses  or  other 
institutions  for  the  aged.  An  old  rectory  or  parsonage  would  generally 
be  the  home  of  a  clergyman  of  the  advanced  cancer  age.  Old  farm- 
houses would  be  most  likely  to  be  used,  if  only  for  sentimental  reasons, 
by  the  aged  members  of  a  family,  of  which  the  younger  members  had 
married  and  gone  to  live  elsewhere.  In  all  of  the  cases  referred  to, 
there  would  be,  in  all  probability,  if  but  as  a  matter  of  coincidence,  a 
larger  proportion  of  aged  persons  of  the  cancer  period  than  in  the  popula- 
tion at  large. 

The  controversial  aspects  of  this  question  can  not  be  reviewed  here 
further  than  by  the  following  quotations  from  the  Twelfth  Annual 
Report  of  the  Imperial  Cancer  Research  Fund  (1914),  which  contains 
an  exceptionally  valuable  review  of  the  literature  of  the  subject  and  some 
instructive  statistical  calculations  and  observations  which  must  be 
considered  a  most  useful  addition  to  our  knowledge  of  this  important 
phase  of  the  cancer  problem.  It  is  said  in  the  report  referred  to,  in 
part,  that  "The  term  'cancer-house'  appears  to  have  been  introduced 
in  1892  by  the  late  Dr.  Law  Webb,  who  was  a  general  practitioner  not 
claiming  special  knowledge  of  pathology  or  bacteriology,  but  who  col- 
lected the  cases  occurring  in  his  practice  and  wrote  as  follows:  *Dr. 
Haviland  insists  that  a  study  of  the  Registrar-General's  returns  shows 
the  existence  of  "cancer-fields"  and  "cancer  areas"  in  this  country,  and 
that  soil  and  situation  have  much  to  do  with  the  mortality  from  this 
disease.  I  would  go  further  and  suggest  that  there  are  cancer-houses 
and  cancerous  wells  or  water-supplies.'  Dr.  Webb  left  the  question 
open  as  to  whether  the  'noxious  material  is  irritating  chemically,  or  is  a 
particulate  body,  such  as  a  bacillus  or  a  protozoon' ;  but  those  who  have 
followed  in  his  wake  have  adopted  the  infective  hypothesis,  and  to  quote 
Dr.  Webb  have  maintained  that  'the  children  of  cancerous  parents 
when  themselves  past  middle  age,  may  contract  the  disease  by  pro- 
longed contact  with  the  sufferer  during  the  nursing  of  a  lingering  case 
or  by  handling  and  washing  linen,  etc.,  soiled  with  discharges.  Again, 
does  this  poison,  or  materies  morbi,  cling  to,  and  infect  certain  localities 
like  the  leprosy  described  in  Leviticus?'  Dr.  Webb  imagined  the 
question  he  had  raised  was  a  perfectly  simple  one,  'A  research  demanding 
neither  laboratory  nor  expensive  instruments  does  not  often  present 
itself  in  these  days;  yet  here  is  one.'  The  idea  of  its  simplicity  is  still 
encouraged,  and  the  public  is  being  misled  by  assertations  as  to  the 
value  of  enumerating  houses  in  which  one  or  more  cases  of  cancer  have 
occurred.  Such  enumerations,  if  they  are  to  have  any  value  at  all, 
could  only  be  preliminary  to  determining  whether  cancer  was  more 
frequent  in  certain  houses  than  was  to  be  expected  if  cases  of  cancer 
were  not  derived  by  communication." 

Pointing  out  that,  on  the  basis  of  the  returns  of  the  Registrar- 
General  for  1911,  the  chance  that  a  man  over  35  years  of  age  will  die 
of  cancer  is  one  in  9.7,  and  the  chance  for  a  woman  above  the  same  age 
is  one  in  7.4,  the  following  table  is  introduced  as  tending  to  show  how 

199 


TBE  MORTALITY  FROM  CANCER 

often  on  the  basis  of  these  proportions  no  death,  or  one,  two,  three,  etc., 
deaths  from  cancer  may  be  expected  to  be  recorded  in  100  famihes,  half 
the  members  of  whicli  are  men  and  half  women,  and  in  which  no  heredi- 
tary tendency  or  infection  is  assumed,  and  in  which  all  persons  dying 
under  35  are  excluded: 

Table  Showing  the  Probability  of  Multiple  Cancer  Cases  in  Groups  of 

Persons  of  the  Numbers  Stated  Without  Assuming 

Hereditary  Tendency  or  Infection 


Number  of 

Cancer  Deaths 

in  Family 

None 

Per  100  Families 
of  6  Members,  viz. 
3  Men,  3  Women 

47 
38 
13 

100 

Per  100  Families 
of  8  Members,  viz. 
4  Men,  4  Women 

36 

39 

19 

6 

100 

Per  100  Families 

of   10  Members,  viz. 

5  Men,  5  Women 

28 

One 

38 

Two 

23 

Three  or  more .... 

11 

100 

It  is  properly  pointed  out  in  this  connection  that  the  determination 
as  to  whether  cancer  is  more  frequent  in  certain  houses  than  in  others  is 
much  more  complex  than  the  simple  arithmetic  of  enumeration.  These 
words  of  caution  can  not  easily  be  overemphasized,  since  a  large  number 
of  factors  and  conditioning  circumstances  require  to  be  known  and 
reduced  to  measurable  and  comparable  proportions.  Dr.  Bashford 
submits  a  fairly  complete  analysis  of  five  of  the  best  known  instances 
of  cancer-houses,  based  upon  special  studies  and  visits  to  the  places 
reported  upon.  The  results  conclusively  prove  at  the  outset  that  some 
of  the  fundamental  requirements  of  statistical  inquiry  were  ignored  and 
that  in  the  main  the  conclusions  throughout  were  made  to  rest  upon  an 
inadequate  numerical  basis  of  fact.  Numerous  actual  and  serious  errors  in 
the  original  statements  were  discovered,  and  subjecting  the  data  to  cor- 
rection, quite  different  conclusions  were  reached.  These  errors  in- 
cluded misstatements  in  age,  occupation,  alleged  site  and  the  certified 
causes  of  death.  Without  enlarging  upon  the  details  of  the  investiga- 
tion, which  appears  to  have  been  made  with  exceptional  thoroughness, 
and  the  complete  results  of  which,  it  is  intimated,  will  be  published  in 
due  course,  the  results  are  summarized  in  the  statement  that  "  'Cancer- 
houses'  are  as  much  a  myth  as  are  'cancer-cages'  [in  connection  with 
experiments  on  animals].  The  advantage  of  the  experimental  method 
is  clearly  brought  out  when  it  is  recalled  that  73,  33,  26,  and  20  years 
of  observation  on  man  have  only  led  to  inconclusive  and,  according  to 
present  knowledge,  quite  erroneous  results.  .  .  .  Some  of  the 
interest  attaching  to  'Cancer  Houses'  and  'Cancer  Villages,'  not 
only  for  laymen  but  also  for  some  members  of  the  medical  profession, 
is  due  to  the  mystery  that  is  made  of  them — the  places  go  unnamed.  " 
A  special  reference  is  made  to  the  case  of  Ayr,  in  Scotland,  where  upon 
subjecting  the  facts  to  qualified  analysis  it  was  found  that  the  pre- 
dominating contributory  condition  to  the  excessive  cancer  death  rate 
was  the  great  preponderance  of  elderly  people  in  the  populations  con- 
sidered. The  discussion  having  been  originally  raised  by  Mr.  D'Arcy 
Powers  in  1898  and  1903,  the  new  facts  were  brought  to  his  knowledge, 

200 


OBSERVATIONS  AND  CONCLUSIONS 

and  he  agreed  with  the  explanation  provided  by  the  additional  data. 
The  hope  is  therefore  expressed  by  the  Director  of  the  Imperial  Cancer 
Research  Fund  that  "the  dangers  of  'cancer-houses'  will  cease  alike  to 
alarm  the  public  and  to  divert  the  energies  of  investigators  from  fruitful 
lines  of  inquiry." 

In  commenting  upon  the  observations  by  Sir  Thomas  Oliver  with 
reference  to  the  same  subject.  The  Lancet,  in  an  editorial  discussion  of 
"Cancer-Houses,"  remarks:  "Conviction  before  the  tribunal  of  public 
opinion  is  liable  to  be  obtained  by  looser  and  easier  methods  than  before 
a  court  jealous  to  observe  and  trained  to  apply  the  laws  of  scientific 
evidence.  The  difficulty  is  to  obtain  a  series  of  houses  in  which  the 
requisite  series  of  cases  of  cancer  can  be  found  to  have  occurred,  and  to 
eliminate  from  those  cases  the  possibility  of  their  having  been  due  as 
much  to  hereditary  tendencies,  which  in  the  sifting  of  evidence  cannot 
be  ruled  out,  or  to  industries  causing  a  predisposition  to  cancer,  or  to 
other  influences.  That  successive  cases  of  cancer  should  appear  in  a 
single  house  or  in  a  group  of  houses  is  not  in  itself  surprising,  for  it  is  not 
a  rare  disease,  population  has  increased,  and  there  are  crowded  areas 
and  houses  in  which  many  persons  will  be  found  who  are  of  the  age 
with  which  the  development  of  cancer  is  associated,  so  that  the  element 
of  coincidence  is  not  easy  to  eliminate.  Unfortunately,  the  romantic 
mind  never  will  try  to  eliminate  it;  the  romantic  mind  revels  in  the 
trouble  caused  by  coincidence," 

Cancer- Villages 

Strictly  localized  intensive  cancer  studies  would  unquestionably  add 
much  material  of  great  value  to  the  cause  of  cancer  research.  Regardless 
of  the  inconclusive  character  of  practically  all  the  observations  on  so- 
called  "cancer-houses,"  "cancer-streets"  and  "cancer- villages,"  the  fact 
is  incontrovertible  that  an  enormous  range  in  cancer  frequency  is  met 
with  throughout  the  world,  and  that  as  yet  no  generally  acceptable 
theory  in  explanation  of  such  a  wide  degree  of  divergence  has  been  ad- 
vanced. An  auspicious  beginning  in  the  direction  of  the  study  of  areas 
of  excessive  cancer  frequency  in  the  state  of  New  York  was  made  by 
Lyon  in  behalf  of  the  New  York  State  Institute  for  the  Study  of  Malig- 
nant Disease.  Lyon  found  an  area  comprising  some  75  square  miles  in 
Brookfield  Township,  Madison  County,  New  York,  in  which  among  a 
relatively  small  population  excessive  cancer  rates  had  prevailed  for 
a  period  of  years.  Unfortunately,  the  investigations  were  discontinued, 
but  as  shown  in  my  address  on  the  Menace  of  Cancer,  the  rate  of  cancer 
frequency  in  this  section  of  Madison  County  has  remained  excessive  to 
the  present  time.  It  is  suggestive  that  this  observer  found  Brookfield  a 
poor  rural  community,  in  which  a  livelihood  was  obtained  with  difficulty. 
The  average  age  at  death  was  54.4  years,  which  would  indicate  a  rather 
high  proportion  of  population  of  the  cancer  age;  but  after  making  allow- 
ance for  the  age  factor,  the  local  cancer  death  rate  was  still  found  to  be 
excessive.  After  discounting  the  factor  of  longevity  and  errors  in 
diagnosis,  Lyon  concludes  that  heredity  and  consanguinity  are  the  special 
factors  that  have  operated  with  peculiar  force  in  Brookfield  to  produce 
the  high  cancer  mortality  over  that  attributable  to  the  factors  already 

201 


THE  MORTALITY  FROM  CANCER 

considered.  He  is  careful  to  point  out  that  the  acceptance  of  the  factor  of 
heredity  does  not  necessarily  commit  one  against  the  parasitic  theory. 
The  evidence  concerning  cancer-houses,  as  such,  was  rather  negative,  and 
cancer  foci  were  not  found  to  exist,  "unless  the  houses  with  multiple  cases 
could  be  so  regarded."  Four  instances  of  cancer  in  husband  and  wife  were 
found.  In  the  main,  the  data  are  inconclusive.  Only  84  deaths  were  con- 
sidered, and  of  this  number  33  were  due  to  cancer  of  the  stomach,  10  to 
cancer  of  the  uterus  and  8  to  cancer  of  the  breast.  The  deaths  were  not 
calculated  on  the  basis  of  the  population  exposed  to  the  risk  of  cancer 
according  to  age,  but  the  proportionate  method  was  used,  which  for  the 
present  purpose,  particularly  in  view  of  the  small  number  of  cases  con- 
sidered, must  be  rejected  as  inadequate.  The  final  conclusion  of  Lyon 
that  the  district  investigated  "represents  a  concentration  of  cancer 
families  rather  than  cancer-houses,"  is  also  debatable,  if  carried  to  the 
point  of  providing  support  for  the  theory  of  hereditary  disease  trans- 
mission. It  is  extremely  regrettable  that  these  investigations  should 
not  have  been  carried  further,  and  that  the  available  data  should  not 
have  been  subjected  to  a  more  critical  and  qualified  analysis. 

It  would  hardly  serve  a  practical  purpose  to  review  in  further  detail 
the  numerous  special  investigations  of  alleged  cancer-houses  or  cancer- 
districts.  The  motive  of  such  studies  to  establish  a  preconceived  theory 
of  infection  or  contagion  discounts  the  scientific  value  of  the  conclusions 
advanced.  Lazarus-Barlow  is  referred  to*  as  having  put  forward  the 
rather  novel  theory  that  the  presence  of  some  radio-active  substance 
in  the  building  material,  or  even  in  the  soil  upon  which  such  (cancer) 
houses  were  erected  might  account  for  the  higher  frequency  of  the 
disease  in  some  localities  or  particular  groups  of  houses  than  in  others. 
The  interesting  statement  is  made  in  this  connection  that  this  point  of 
view  did  not  "necessarily  conflict  with  Cohnheim's  theory  of  embryonic 
rests  or  with  Virchow's  theory  of  mechanical  irritation  or  with  Adami's 
theory  of  habit  of  growth,  since  radioactivity  in  the  causative  agent 
or  in  the  tissues  might  be  the  underlying  force  in  each.  Even  the 
microbic  theory  might  be  reconciled  with  this  idea,  for  it  is  supposable 
that  the  assumed  bacterial  or  protozoan  agent  in  such  case  might  be 
radioactive."  The  evidence  advanced,  however,  can  not  be  considered 
final,  but,  as  observed  in  the  discussion  referred  to,  "Nevertheless 
this  work,  inconclusive  as  it  is  in  its  results,  is  deserving  of  careful 
study  and  extension.  .  .  .  Further  investigations  along  this  line 
may  indeed  explain  away  discrepancies  now  precluding  an  acceptance  of 
the  theory  of  infection,  but  even  should  they  fail  to  do  so,  work  of  this 
kind  is  never  fruitless  and  it  may  prove  to  have  an  important  bearing 
on  other  biological  problems,  even  if  it  does  not  explain  the  origin  of 
cancer." 

Evidence  of  Parasitical  Origin  Not  Conclusive 

Briefly  reviewing  some  of  the  most  important  contributions  to  the 
study  of  the  possible  parasitical  origin  of  cancer,  mention  may  be  made 
of  the  following:  Hoeber  has  reported  for  Augsburg,  Germany,!  the 
results  of  an  extended  investigation,  presented  in  a  number  of  tables 

'Medical  Record,  New  York,  August  7,  1909. 

tZeitschrift  flir  Krebsforschung,  Jena,  1904,  Vol.  i,  p.  173. 

202 


OBSERVATIONS  AND  CONCLUSIONS 

and  maps,  showing  the  cancer-houses,  the  soil  and  geological  foundation, 
etc.,  and  the  coincidence  of  tuberculosis,  but  he  was  unable  to  discover 
any  connection  between  the  occurrence  of  cancer  and  the  height,  drainage 
and  other  conditions  of  the  houses.  He  found  that  both  cancer  and 
tuberculosis  were  most  prevalent  in  the  poorer  quarters.*  In  the 
Thames  Valley,  the  statistics  of  all  the  counties  indicate  a  cancer  death 
rate  above  the  average  for  England  as  a  whole.  "The  statistics 
seem  to  justify  the  conclusion  that  this  section  has  a  relatively  high 
mortality  from  cancer  and  the  uniformly  high  rate  on  both  of  the  banks 
suggests  that  there  may  be  a  connection  between  the  river  floods  and  the 
extent  of  the  disease,"  which, however,  is  not  explained  on  the  assumption 
of  a  parasitical  origin  of  the  disease.  These  studies  suggest  that  the 
drying  vegetation  on  the  river-banks  may  be  a  favorable  nidus  for  the 
growth  of  the  parasite,  but  this  would  not  explain  the  increase  of  cancer, 
which  seems  everywhere  apparent. f 

It  has  been  pointed  out  in  this  connection,  in  the  Journal  of  the 
American  Medical  Association,  March  25,  1905,  commenting  upon 
recent  contributions  to  the  literature  of  cancer  parasites  by  Robertson 
and  Wade,  following  Behla  and  Gay  lord,  that  "The  fallacy  of  the  cancer 
house  theory,  however,  has  been  proved  by  the  careful  work  of  Lyon, 
who  has  shown  that  house  collections  of  cases  are  far  better  explained 
by  the  influence  of  heredity  and  an  in-and-in  breeding  than  by  infec- 
tion." Referring  to  the  investigations  of  Dr.  Munch  Soegaard  of  Norway, 
the  British  Medical  Journal  of  December  24,  1910,  remarks  that 

Since  the  total  number  of  cases  with  which  he  deals  is  so  small,  and  the  possibilities  of 
error  are  so  large,  it  is  unnecessary  to  follow  up  his  cases  any  further  in  respect  to  inheri- 
tance. We  may,  therefore,  register  the  verdict  with  regard  to  this  account  as  "not  proven." 
He  calls  the  cottages  in  which  some  of  the  patients  lived  and  died  "Krebshofen,"  or  cancer 
cottages.  His  observations  lead  him  to  summarize  that  in  18  out  of  68  cases  the  cancer 
patient  had  lived  in  intimate  contact  with  another  cancer  patient.  The  cottages  or 
"Hofe"  are  described  in  vivid  colors,  and  certainly  appear  to  be  veritable  insanitary  nests, 
in  which  infection  might  readily  occur.  But  where  overcrowding  and  other  evils  are 
found,  it  must  be  assumed  that  other  factors  of  a  deteriorating  type  must  also  prevail, 
and  the  mere  occurrence  of  cancer  in  several  persons  living  in  these  hovels  does  not  prove 
infection.  In  the  same  way,  when  he  tries  to  prove  infection  by  citing  the  experience  that 
those  persons  who  left  the  neighborhood  to  live  elsewhere  escaped  from  the  ravages  of 
the  terrible  malady,  while  those  who  remained  at  home  were  more  or  less  attacked,  it 
must  be  emphasized  that  other  factors  have  to  be  taken  into  consideration,  of  which  the 
mode  of  feeding,  the  habits  with  regard  to  irritation  and  local  stimulation,  may  be  in- 
stanced. Again,  it  is  inconceivable  that  one  infection  should  at  times  produce  carcinoma, 
and  at  other  times  sarcoma,  and  at  still  others  rodent  ulcer.  Dr.  Soegaard  records  cases 
of  all  three  arising  in  one  and  the  same  environment. 

The  cancer  census  of  Baden  is  briefly  referred  to  in  the  Journal  of 
the  American  Medical  Association  for  October  12,  1911,  as  follows: 

Werner's  exhaustive  study  of  conditions  in  the  state  of  Baden  in  regard  to  the  occur- 
rence of  cancer,  seems  to  show  that  external  factors,  physical,  chemical  or  parasitic,  com- 
pletely overshadow  in  importance  the  biologic-hereditary  factors.  In  the  cases  of  con- 
jugal cancer,  the  organs  involved  excluded  direct  contact  as  the  growths  were  generally 
in  the  stomach,  and  never  on  the  skin,  lip  or  genital  organs.  Contact  infection  is  ren- 
dered improbable  further  by  his  figures  showing  that  cancer  is  least  prevalent  in  the 
predominantly  industrial  communities.  It  seems  to  occur  according  to  laws  which  have 
been  seen  to  prevail  in  the  occurrence  of  the  non-contagious  infectious  diseases  connected 
with  local  conditions.     This  fact  affords  new  evidence  as  to  a  possible  parasitic  origin  of 

*  Journal  of  the  American  Medical  Association,  March  26,  1904. 

]  Journal  of  the  American  Medical  Association,  April  30,  1904. 

203 


THE  MORTALITY  FROM  CANCER 

cancer.  An  inherited  predisposition  is  not  the  prominent  factor  previously  assumed  or 
the  influence  of  heredity  would  have  been  more  apparent  in  the  data  he  has  collected. 
In  some  of  the  districts  the  number  of  cases  is  steadily  decreasing,  in  others  increasing; 
twelve  communities  were  entirely  free  and  1,001  had  much  less  than  the  general  average, 
while  575  had  much  above  the  average,  but  no  common  geologic,  hydrographic,  climatic 
or  architectural  factors  could  be  detected  as  responsible  for  this  frequency  or  scarcity  of 
cancer,  nor  age,  sex,  social  standing,  race,  occupation  or  diet,  nor  distribution  of  the 
fauna  and  flora  of  the  district.  Werner's  recent  more  detailed  study  of  twenty-seven  of 
the  places  where  cancer  is  most  prevalent  and  forty-six  where  it  is  least  so  has  demon- 
strated anew  that  the  difference  in  prevalence  of  cancer  cannot  be  explained  by  the  differ- 
ence in  the  proportion  of  elderly  persons,  but  seems  to  be  connected  in  some  way  with 
the  place. 

In  the  same  discussion  the  conclusion  is  advanced  with  reference  to 
cancer  frequency  among  blood  relations  and  cancer-houses  that 

These  data  completely  disprove  the  assumption  of  cancer  families,  but  add  new  sup- 
port to  the  assumption  of  cancer  houses  and  neighborhoods. 

Sir  George  Beatson  in  a  discussion  of  the  cancer  statistics  of  Scotland 
for  the  period  1861-1900,  read  before  the  Royal  Society  of  Edinburgh, 
brought  forward  some  rather  interesting  views  on  the  cancer  problem, 
briefly  summarized  in  the  statement  that: 

Cancer  as  a  disease  occurs  not  In  the  decline  of  life  but  on  the  cessation  of  reproduc- 
tive life.  Climate  and  geological  conditions  do  not  affect  the  question.  Whether  so- 
called  "cancer  homes"  are  instances  of  coincidence  or  not  is  not  settled.  The  only  pre- 
ventive measure  which  suggests  itself  as  of  any  value  is  notification  which  would  give 
more  accurate  information  as  to  where  the  disease  arises.* 

Poppelmann  is  authority  for  the  statement,  based,  however,  upon 
only  85  cases  of  cancer  in  a  town  of  8,000  inhabitants,  that  "the  results 
show  that  the  houses  which  stood  nearest  to  water  courses,  and  especially 
to  stagnant  water,  showed  much  the  larger  proportion  of  cancer  cases. 
The  principal  focus  proved  to  be  the  region  from  the  backwater  from  a 
dam."  He  urges  the  compilation  of  statistics,  with  maps,  of  small  towns, 
where  conditions  are  better  known  than  in  cities,  with  a  special  regard, 
however,  to  the  location  of  cancer  deaths  in  houses  near  brooks,  rivers 
and  dams. 

From  quite  another  point  of  view  the  subject  has  been  approached  by 
Wilfred  Watkins-Pitchford,  Government  Pathologist  of  Natal,  in  a  paper 
on  Light,  Pigmentation  and  New  Growth,t  who  points  out  that  "Cancer 
has  been  found  to  be  slightly  more  prevalent  among  those  who  are  the 
more  exposed  to  actinic  stimulation — seamen,  dwellers  beside  lakes  and 
rivers,  agricultural  laborers,  etc.,  etc.,"  and  "Cancer  houses  usually 
appear  to  be  unwholesome  dwellings,  often  affording  special  facilities  in 
their  immediate  neighborhood  for  the  irradiation  of  their  anemic  in- 
habitants." 

Commenting  upon  the  local  incidence  of  cancer  in  New  Zealand, 
Hislop  and  Fen  wick,  J  after  referring  to  the  investigations  of  D'Arcy 
Power  conclude  that  "The  neighborhood  of  the  native  bush  and  bush 
streams  seems  to  have  some  distinct  connection  in  the  origin  of  the  disease. 
Malaria  may  not  be  antagonistic  to  cancer,  but  it  is  significant  that  where 
malaria  is  common  cancer  appears  to  be  rare.  It  may  not  be  improbable 
that  there  is  some  malarial  poison  antagonistic  to  the  growth  of  cancer 

*Medical  Record,  New  York,  July  6,  1912. 
^British  Medical  Journal,  August  Zl,  1909, 
tBritish  Medical  Journal,  October  23,  1909. 


OBSERVATIONS  AND  CONCLUSIONS 

cells.  So  many  of  the  cases  were  rheumatic,  and  rheumatism  is  so  prev- 
alent in  subacute  or  chronic  forms  in  bush  districts,  that  we  can  hardly 
ascribe  the  coincidence  of  cancer  and  rheumatism  to  an  accident.  It  is 
not  impossible  to  imagine  that  the  circulation  of  the  blood  in  rheumatic 
cases  may  act  as  a  direct  irritant  to  the  tissues."  In  the  case  of  most  of 
these  investigations  the  facts  relied  upon  are,  as  a  rule,  entirely  inade- 
quate for  the  purpose  of  establishing  a  scientific  theory  of  cancer  correla- 
tion to  local  conditions  more  or  less  superficially  described.  The  evi- 
dence regarding  specific  cancer-carriers  has  not  been  forthcoming, 
although  at  the  second  International  Cancer  Conference*  Dr.  Borrel 
gave  an  account  of  his  views  on  "the  possibility  of  cestodes  and  Demodex 
fulfilling  the  part  of  intermediate  hosts  or  carriers  of  a  hypothetical 
cancer  virus."  This  view  has  been  vigorously  criticized  and  has  not 
been  generally  accepted. 

Equally  inconclusive  were  the  results  of  a  special  study  by  Dr.  George 
D.  White  of  five  cases  of  cancer  with  four  deaths  in  a  certain  district 
of  Jersey  City,  particularly  for  the  purpose  of  proving  the  possibility  of 
contagion  or  the  parasitical  or  bacteriological  factor  in  the  propagation 
of  malignant  disease. 

It  has  seemed  necessary  to  review  at  some  length  the  salient  points  of 
a  controversy  of  long  standing  in  view  of  the  practical  importance  of  the 
question  whether  cancer  frequency  can  be  precisely  correlated  to  specific 
determinable  local  factors  or  conditions.  In  view  of  the  truly  enormous 
frequency  of  cancer,  it  would  seem  a  foregone  conclusion  that  if  such  a 
correlation  existed,  it  would  not  be  difficult  to  provide  the  necessary 
indisputable  evidence.  The  proof,  as  far  as  can  be  gathered  from  a  care- 
ful reconsideration  of  the  published  evidence,  is,  therefore,  opposed  to  the 
theory  of  the  parasitical  origin  of  malignant  disease  and  its  spread  by 
personal  contact  or  by  transmission  from  person  to  person  by  some 
carrier  at  present  unknown.f 

Cancer  a  Deux  or  Infection  of  Husband  and  Wife 

Closely  allied,  in  fact  interminably  interwoven  with  the  theory  of 
cancer-houses,  is  the  theory  of  cancer  infection  of  husband  and  wife. 
There  are,  no  doubt,  cases  of  coincident  cancer  occurrence  in  husband 
and  wife,  and  in  a  very  few  of  these  cases  the  form  of  cancer  in  both  has 
been  the  same.  Weinberg  found  that  in  Stuttgart,  during  the  period 
1873-1902,  of  the  widowers  and  widows  dying  of  cancer,  the  frequency 

*British  Medical  Journal,  October  22, 1910. 

fThe  following  is  a  suggestive  reference  to  the  relation  of  cancer  to  locality,  by  W.  S.  Lazarus-Barlow,  in  his 
third  lecture  on  Radio-Activity  and  Carcinoma  (British  Medical  Journal,  June  26, 1909):  "On  the  other  hand, 
it  [the  theory  of  the  radio-activity  of  scotographic  materials]  would  not  be  opposed  to  a  belief  in  'cancer 
houses  and  localities,'  for  there  is  no  reason  why  the  soils  of  districts  or  the  materials  of  which  houses  are  built 
should  not  differ  in  the  degree  to  which  they  are  radio-active,  nor  why  the  local  radio-activity  should  not  be  in 
certain  instances  so  considerable  that  cancer  arises  in  successive  inhabitants  time  after  time.  In  a  sense  the 
electrical  department  of  every  hospital  is  a  'cancer  house.'  It  would  not  be  opposed  either  to  an  infective  or 
non-infective,  a  contagious  or  non-contagious,  an  animal  or  vegetable  parasitic,  a  parasitic  or  non-parasitic,  a 
hereditary  or  non-hereditary  view  of  cancer,  for  it  would  only  be  concerned  with  the  question  whether  the  in- 
culpated agent  is  radio-active  or  not.  So  far  as  certain  bacteria  possessed  the  properties  we  are  considering, 
the  carcinoma  associated  with  them  might  be  regarded  as  bacterial  and  infective,  but  the  bacterial  and  infective 
properties  would  be  accidental  and  non-essential.  So  far  as  the  agent  which  leads  to  hereditary  transmission 
was  provided  with  'radio-active'  properties  cancer  would  be  hereditary,  but  the  inheritance  of  cancer  would  be 
accidental  and  non-essential.  Similarly  it  would  not  be  opposed  to  Cohnheim's  theory  of  embryonic  rests,  to 
Virchow's  theory  of  mechanical  irritation,  to  von  Hansemann's  theory  of  anaplasia,  to  Ribbert's  theory  of  tissue 
tension,  to  Adami's  theory  of  habit  of  growth — for  it  would  constitute  the  underlying  force  required  by  each." 

205 


TEE  MORTALITY  FROM  CANCER 

rate  in  proportion  to  the  population  was  not  above  the  average. 
Frief  of  Breslau  determined  the  number  of  cancer  cases  among  surviving 
husbands  and  wives,  but  the  mortality  was  not  abnormal.  Smith 
of  Santa  Clara,  California,  in  1895  reported  the  case  of  a  woman 
68  years  of  age  whose  death  from  cancer  of  the  breast  was,  six  months 
later,  followed  by  the  occurrence  of  cancer  of  the  stomach  and  liver  in 
her  husband.  Such  cases,  however,  are  apparently  merely  a  matter  of 
coincidence  or  pure  chance.  If  cancer  were  in  any  appreciable  number 
of  cases  transmitted  from  husband  to  wife,  or  vice  versa,  the  number  of 
recorded  cases  should  be  very  large,  in  view  of  the  general  frequency 
of  the  disease  after  forty.  The  precarious  nature  of  the  statistical  data 
on  the  subject  is  best  illustrated  in  the  results  of  the  Baden  Cancer 
Census,  according  to  which  the  suspicion  of  direct  cancer  transmission 
from  person  to  person  was  indicated  in  the  returns  for  1904  in  the 
proportion  of  4.8  per  cent,  and  in  the  returns  for  1906  in  the  proportion 
of  10.7  per  cent,  of  all  the  cancer  cases  under  observation.* 

The  same  question  was  considered  in  the  Hungarian  cancer  census  from 
the  point  of  %new  of  direct  contact,  of  living  together  in  the  same  house 
and  of  contact  with  cancerous  animals,  but  the  results  were  inconclusive. 
Only  two  cases  were  recorded  in  which  there  might  possibly  have  been 
cancer  infection  as  a  result  of  marital  relations,  but  such  statistical 
evidence  unsupported  by  additional  details  derived  from  medical 
sources  can  not  be  considered  conclusive.  It  has  been  observed  in  this 
connection  by  W.  Roger  WiUiams  that  "If  cancer  could  be  proved  to  be 
an  inoculable  contagious  maladyj  the  question  as  to  its  causation  would 
be  greatly  simplified,  in  favor  of  extrinsic  factors ;  but,  so  far  as  we  have 
hitherto  examined  this  question,  no  reliable  evidence  of  contagion 
has  been  forthcoming."  Referring  to  his  eight  years'  experience  at 
the  ISIiddlesex.  Hospital,  he  adds  that  he  had  never  noticed  "a  single 
fact  that  could  possibly  be  construed  as  evidence  of  the  communicabil- 
ity  of  malignant  disease  from  one  human  being  to  another,"  but  to  the 
contrary,  he  noticed  "many  indications  which  seemed  clearly  to  imply, 
that  the  disease  was  neither  infectious  nor  contagious."  He  reviews  the 
evidence  published  from  time  to  time  regarding  the  recorded  cases  of 
transmission  of  cancer  from  one  human  being  to  another,  but  he  con- 
cludes that  "the  evidence  adduced  as  to  contagion  in  these  cases  is  of 
such  a  flimsy  and  obviously  unreliable  nature  as  to  absolve  me  from 
the  necessity  of  detailed  refutation." 

No  Surgical  Infection  in  Cancer  Operations 
If  cancer  were  contagious,  infectious,  or,  in  other  words,  transmissible 
from  one  person  to  another,  it  would  naturally  be  expected  that  sur- 
geons employed  in  cancer  operations  would,  at  least  occasionally,  fall  a 
victim  to  the  malady  in  the  course  of  their  occupation.  Cases  of 
surgical  infection  are  by  no  means  uncommon  in  the  case  of  many  in- 
fectious or  contagious  diseases,  but  there  is  not  a  trustworthy  recorded 
case  of  a  surgeon  having  acquired  the  disease  in  the  course  of  contact 

*The  identical  question  is  raised  in  discussions  of  the  relative  frequency  of  tuberculosis  in  husband  and 
wife.  The  matter  has  been  thoroughly  considered  by  Longstaff  in  his  "Studies  in  Statistics,"  in  a  chapter  on 
a  Calculation  of  the  Probability  of  the  Accidental  and  Fatal  Incidence  of  Phthisis  upon  Both  Husband  and 
Wife,  London,  1891,  p.  384.  The  negative  conclusions  arrived  at  apply  with  equal  force  to  the  theoretical 
probability  of  cancer  infection  of  husband  and  wife. 

206 


OBSERVATIONS  AND  CONCLUSIONS 

in  consequence  of  surgical  operations  for  cancer.  Dr.  George  W.  Crile, 
in  his  oration  on  Surgery  at  the  Fifty-ninth  Annual  Session  of  the 
American  Medical  Association,  after  reviewing  the  few  spontaneous 
cancers  that  have  been  successfully  transplanted  from  one  animal 
to  another  of  the  same  species  and  after  mentioning  the  fact  that 
no  cancer  has  as  yet  been  successfully  transplanted  from  one  animal 
species  to  another  species,  points  out  that  the  surgeon's  immunity  from 
cancer  infection  during  cancer  operations  is  practically  complete. 
Dr.  Willy  Meyer,  in  an  address  before  the  Cancer  Research  Institute,* 
in  reply  to  the  question  as  to  whether  cancer  was  infectious  or  con- 
tagious, or  both,  observes  that,  "One  had  never  seen  nor  heard  of  a 
patient  afflicted  with  the  disease  conveying  it  to  his  wife.  Nor  had  they 
ever  heard  of  a  nurse  caring  for  a  patient  with  carcinoma  for  months 
ever  becoming  stricken  with  the  disease.  Nor  had  he  ever  heard  of  a 
surgeon  who,  for  instance,  had  injured  his  finger  during  the  perform- 
ance of  some  operation  on  a  cancerous  subject  ever  developing  cancer. 
It  did  therefore  not  appear  that  cancer  could  be  conveyed  from  one 
person  to  another  in  this  way,  and  therefore  the  disease  could  not  be 
considered  infectious." 

Dr.  J.  W.  Vaughan,  in  an  address  on  "Some  Modern  Ideas  of  Can- 
cer,"! concludes,  in  regard  to  contact  tumors  and  direct  infection,  that 
"Surgeons  have  been  removing  cancers  since  the  time  of  Hippocrates, 
and  as  yet  no  case  of  infection  from  such  a  source  has  ever  been 
observed."  Rodman,  in  an  address  on  cancer  read  in  the  section  on 
Surgery  and  Anatomy  of  the  American  Medical  Association,  at  the  Fifty- 
sixth  Annual  Session,  remarks  that  "The  rarity  of,  if  not  unheard  of,  infec- 
tion of  operating  surgeons  by  cancerous  patients  is  the  strongest  possible 
evidence  against  the  parasitic  nature  of  the  disease."!  It  would  serve 
no  purpose  to  add  to  the  foregoing  the  available  additional  evidence  from 
other  sources  in  support  of  the  contention  that  in  the  light  of  our  present 
knowledge  cancer  is  not  an  infectious  or  contagious,  or,  in  other  words, 
a  transmissible  disease  from  person  to  person  by  contact,  or  by  other 
means  of  germ  conveyance.  If  future  researches  along  the  line  of  the 
admirable  work  of  Roncali  into  the  minute  study  of  the  blastomycetes 
should  prove  successful,  and  establish  the  parasitical  origin  of  cancer, 
it  will  no  doubt  be  found  that  the  nature  of  the  organism  varies  funda- 
mentally and  essentially  from  the  animal  or  vegetable  parasites  respon- 
sible for  the  transmission  of  the  so-called  contagious  or  infectious  dis- 
eases best  typified  by  typhoid,  smallpox  and  diphtheria. 

Cancer  Not  Caused  by  Worry 

The  public  agitation  of  the  cancer  problem  has  aroused  opposition  on 
the  part  of  those  apprehensive  that  those  predisposed  to  the  disease 
or  actually  suffering  therefrom  may  be  unduly  alarmed,  and  that  those 
practically  free  therefrom  may  be  mentally  disturbed  to  the  point  of 
hysteria  or  cancerphobia.  The  evidence  at  present  available  and  briefly 
restated  in  the  preceding  discussion  should  allay  the  reasonable  anxiety 

*Medical  Record,  October  11, 1913. 

^Journal  of  the  American  Medical  Association,  May  7, 1910. 

tJournal  of  the  American  Medical  Association,  September  30,  1905. 

207 


TEE  MORTALITY  FROM  CANCER 

on  the  part  of  the  public,  first,  in  regard  to  the  possible  heredity  of  cancer, 
and  second,  in  regard  to  the  remotely  possible  but  not  probable  trans- 
mission of  the  disease  by  personal  contact  or  in  some  more  subtle  and  less 
readily  determinable  way.  To  this  may  be  added  the  assurance  that 
cancer  is  not  caused  by  worry,  any  more  than  smallpox  or  yellow  fever. 
Worry  has  been  defined  as  "the  restless  consciousness  of  all  encumbrances 
which  we  accept  under  protest."  "The  fact,  however,  cannot  be  too 
strongly  emphasized,"  in  the  words  of  Dr.  E.  D.  Forrest,  "that  the 
primary  mental  condition  is  one  of  overactivity,  and  moreover,  over- 
activity along  lines  of  fijxed  ideas."  According  to  the  same  authority,  the 
physical  manifestations  of  worry  in  general  are  "depression  of  respira- 
tion, sighing,  disturbances  in  rate  and  force  of  heart  beat,  vasomotor 
changes,  disturbances  in  secretion,  pallor,  cold  extremities,  relaxation 
and  decreased  motility  of  the  alimentary  tract,  dilatation  of  the  pupil, 
loss  of  weight,  insomnia  and  general  physical  exhaustion."  Considered 
from  this  point  of  view,  it  is  held  that  worry  may  sometimes  be  an  im- 
portant contributory  factor  in  the  production  of  diabetes,  gout,  ex- 
ophthalmic goitre  and  chronic  heart  disease.  It  might  seem  a  reason- 
able inference  that  under  these  conditions  worry  might  also  be  a  con- 
tributory factor  in  cancer,  but  this  conclusion  does  not  necessarily  follow. 
Disturbances  in  secretion,  no  doubt,  might  lead  to  local  irritation  and 
thus  further  the  development  of  precancerous  conditions  arising  out  of 
errors  in  nutrition;  but  there  probably  would  have  been  cancer  without 
worry,  as  it  is  conceivable  that  the  disease  would  have  been  assisted  in  its 
development  by  mental  overactivity  along  lines  of  fixed  ideas. 

Cancer  and  Insanity 

This  question  has  been  quite  fully  discussed  by  Romer,  of  Stuttgart, 
in  a  contribution  to  the  "Journal  of  the  German  Cancer  Society"  (1906). 
Groundless  fear  of  cancer  as  a  cause  of  insanity  is  referred  to  by  Romer  as 
having  been  observed  in  rare  individual  cases,  but  the  same  argument 
would  apply  against  countless  other  factors  of  suggestion  more  or  less 
conceivable  as  contributory  causes  of  mental  disease.  Romer  objects  to 
the  public  agitation  of  the  cancer  problem,  particularly  on  the  ground  of 
cancer  increase,  which,  he  maintains,  has  not  been  proved,  nor  even 
made  evident  as  a  question  of  abstract  probability.  He  directs  attention 
to  the  fear  of  inheritance  in  cancer  as  a  predisposing  cause  of  insanity, 
even  though  this  apprehension  is  well  known  to  be  practically  without 
trustworthy  evidence.  He  also  apprehends  serious  results  from  a 
spreading  conviction  that  cancer  is  a  contagious  or  transmissible  dis- 
ease, but  he  fails  to  furnish  the  necessary  statistical  evidence  that  cancer 
fear  or  cancer  apprehension  is  taken  note  of  to  an  appreciable  extent  as  a 
contributory  condition  in  the  admissions  to  asylums  for  the  insane.* 
He  concedes  the  great  importance  of  cancer  education  as  a  first  step 
towards  the  possible  public  control  of  the  disease  on  the  basis  of  a  rational 
understanding  regarding  the  supreme  importance  of  qualified  attention, 

*Cancer  worry  or  cancer  fear  is  not  referred  to  as  a  predisposing  cause  of  insanity  by  Bernard  Hollander 
in  hi3  treatise  on  "The  First  Signs  of  Insanity,"  nor  by  T.  S.  Clouston  in  his  work  on  "Unsoundness  of  Mind." 
Other  diseases,  such  as  influenza,  circulatory  disturbances,  even  child-bearing,  exhaustion  and  fatigue,  are 
mentioned,  but  there  is  no  reference  to  cancer  or  to  tumors  of  the  non-malignant  type.  Charles  Mercier,  in  his 
treatise  on  "Sanity  and  Insanity,"  and  Henry  Maudsley,  in  his  work  on  "Responsibility  in  Mental  Disease," 
do  not  mention  cancer  as  a  contributory  factor  in  insanity. 

208 


OBSERVATIONS  AND  CONCLUSIONS 

medical  or  surgical,  on  the  recognition  of  the  earliest  symptoms.  The 
danger  of  encouraging  persons  needlessly  alarmed  about  cancer  to 
seek  the  advice  of  alleged  cancer  specialists  or  to  place  faith  in  alleged 
cancer  cures,  with  the  increased  certainty  of  fatal  results,  is  well  to 
the  point,  and  deserving  of  serious  thought.  He  argues  that  in  the 
main  the  educational  efforts  should  be  through  the  medium  of  the 
family  physician  of  the  patient,  but  the  difficulty  in  this  respect  is  a 
practical  one,  in  that  the  vast  majority  of  cancer  patients  have  not  the 
least  conception  of  the  extreme  seriousness  of  the  earliest  symptoms  and 
therefore  do  not  seek  the  advice  of  even  the  family  physician  until  the 
cancerous  growth  has  reached  a  stage  where  the  disease  has  practically 
extended  more  or  less  to  the  adjoining  glands  or  parts  and  thus  reached  a 
more  or  less  inoperable  stage.  Romer  concludes  that  the  problem  is 
largely  one  of  increased  cooperation  between  physicians  and  surgeons, 
on  the  one  hand,  and  a  more  perfect  mutual  understanding  and  confidence 
between  patient  and  physician,  on  the  other.  The  enormous  mortality 
from  cancer  throughout  the  world  and  the  obvious  increase  in  the  rate  of 
cancer  frequency  bear  witness  to  the  fact  that  no  progress  towards  cancer 
mortality  control  is  likely  to  be  made  along  these  very  general  and 
rather  superficial  lines  of  an  understanding  on  the  part  of  the  profession 
and  the  public  of  the  menace  and  the  urgency  of  the  earliest  practicable 
removal  of  the  offending  cancerous  growth. 

Radium  and  Radiotherapy 

A  thoroughly  qualified  statistical  inquiry  into  the  results  of  cancer 
treatment  would  make  an  extremely  valuable  contribution  to  the  cause 
of  cancer  research.  A  large  amount  of  statistical  information  has  been 
published  on  the  results  of  surgical  operations,  but  the  methods  of 
statistical  analysis  have,  as  a  rule,  been  crude  and  often  not  free  from 
serious  technical  objections.  In  the  case  of  the  non-surgical  treatment 
of  cancer  the  statistical  considerations  are  even  more  involved,  and  the 
conclusions  advanced  are  less  to  be  relied  upon  as  impartial  and  accurate. 
The  underlying  reason  is  to  be  found  in  the  widely  varying  and  statis- 
tically ill-defined  principles  of  medical  and  surgical  practice;  in  other 
words,  it  is  extremely  difficult,  if  not  practically  impossible,  to  reduce 
the  cases  considered  to  an  absolutely  comparable  basis.  For  illustra- 
tion, one  institution  may  treat  largely  inoperable  cases,  as  a  matter  of 
charity  or  positive  necessity;  another  institution  may  treat  only  such 
cases  as  upon  thorough  examination  warrant  an  exceptionally  favorable 
prognosis ;  yet  the  first  of  the  two  might  actually  be  better  adminstered 
and  yield  relatively  more  favorable  results  than  the  second.  It  is  therefore 
obvious  that  statistical  conclusions  regarding  methods  of  treatment 
require  to  be  accepted  with  extreme  caution. 

These  observations  apply  with  special  force  to  radiotherapy  as  a 
possible  solution  of  the  apparently  hopeless  problem  of  an  effective 
cancer  cure  by  other  means  than  radical  surgical  interference  The 
subject  of  radium,  however,  has  attracted  so  much  attention  within  the 
last  few  years  that  it  has  seemed  advisable  to  include  a  brief  discussion 
of  it,  regardless  of  the  rather  doubtful  value  of  the  statistical  evidence 
available  at  the  present  time.      The  opinion  has  been  expressed  by 

209 


THE  MORTALITY  FROM  CANCER 

Mr.  A.  E.  Hay  ward  Pinch,  the  medical  superintendent  of  the  Radium 
Institute  of  London,  that  "No  useful  purpose  would  be  served  by  a  mi- 
nute analysis  of  the  statistics,"  for,  as  observed  by  the  British  Medical 
Journal,  "the  stages  and  extent  of  the  disease  vary  so  much  from  case 
to  case  that  only  a  very  large  number  would  warrant  the  use  of  the 
statistical  method."  Subsequently,  however,  some  very  interesting 
statistics  have  been  published  by  the  Institute,  which  will  presently 
be  discussed  in  some  detail.  It  requires  to  be  kept  in  mind  that  the 
modern  surgical  treatment  of  cancer  is  unquestionably  much  more 
effective  than  the  surgical  practice  of  the  past  and  that  the  results  ob- 
tained are  in  almost  precise  relation  to  the  previous  duration  of  the 
disease,  or,  in  other  words,  to  the  attained  size  and  degree  of  infiltration 
of  the  cancerous  mass  into  the  adjacent  tissue  through  the  regional 
lymphatic  glands.  The  average  surgical  results,  under  normal  con- 
ditions, have  been  summarized  by  Dr.  Isaac  Levin,  in  the  following 
statement : 

Only  in  carcinoma  of  the  lip  the  radical  cure  by  the  aid  of  the  so-called  block  dissection 
of  the  tumor  and  the  regional  lymph  glands  is  as  high  as  70  to  83  per  cent.  In  carcinoma 
of  the  breast  Halstead,  who  is  one  of  the  best  operators  of  this  condition,  reports  that  38.8 
per  cent,  of  the  cases  which  were  operated  remained  well  for  three  years  and  over.  Since 
not  all  the  cases  examined  were  operable,  probably  not  more  than  30  per  cent,  of  the  cases 
of  carcinoma  of  the  breast  can  be  cured  by  surgery  alone.  In  regard  to  carcinoma  of  the 
uterus  Wertheim,  the  greatest  authority  on  the  surgical  treatment  of  this  condition, 
states  that  about  one  half  of  the  cases  which  come  to  him  are  operable  and  of  these  about 
one-half  are  cured  by  the  operation,  consequently  about  25  per  cent,  of  the  cases  of  car- 
cinoma of  the  uterus  may  be  cured  by  operative  treatment.  Wm.  J,  Mayo,  who  is  one  of 
the  most  brilliant  operators  in  the  world,  reported  recently  on  996  cases  of  carcinoma  of 
the  stomach.  Of  these  344  cases  only  were  operable  and  of  the  latter  25  per  cent,  remained 
cured  five  years  and  over  after  the  operation.  In  other  words,  about  9  per  cent,  of  cases 
of  carcinoma  of  the  stomach  can  be  cured  by  surgery  alone  in  the  hands  of  a  Mayo  and 
probably  an  even  smaller  percentage  in  the  hands  of  most  other  surgeons.  In  all  rather 
less  than  30  per  cent,  of  cancer  patients  can  hope  to  be  cured  by  the  aid  of  surgery  alone.* 

It  must  be  admitted  that  these  results  are  disappointing,  considering 
the  high  degree  of  surgical  efficiency  on  the  part  of  those  who  are  right- 
fully considered  the  master  minds  of  the  surgical  profession,  but  Dr. 
Levin  is  far  from  being  justified  in  his  conclusion  that  "It  is  also  safe 
to  assume  that  there  can  hardly  be  expected  any  further  progress  in 
surgical  treatment  of  malignant  tumors,"  for  the  self-evident  reason 
that  in  the  past  the  large  majority  of  the  cancer  patients  obtained  sur- 
gical treatment  at  a  time  when  the  cancerous  growth  had  probably 
reached  the  inoperable  stage.  These  observations  seem  called  for  in 
view  of  the  reasons  advanced  in  behalf  of  the  radium  treatment  as  a 
substitute  for  surgical  interference,  even  though  evidence  is  wanting 
to  prove  that  radiotherapy  would  be  applicable  to  the  large  majority 
of  deep-seated  cancers,  which  cause  the  major  portion  of  the  aggregate 
mortality  from  malignant  disease. 

Radiotherapy  is  a  branch  of  physiotherapy,  which  includes  treatment 
by  heat,  light,  electricity  and  radio-activity.  A  brief  outline  of  the 
principles  of  physiotherapy  in  its  relation  to  cancer  is  contained  in  the 
treatise  on  "The  Cancer  Problem,"  by  William  Seaman  Bainbridge, 
who  refers  to  the  discovery  of  Roentgen  rays  in  1895,  which  were  also 

'Isaac  Levin,  "The  Relation  Between  the  Surgical  Treatment  and  Radiotherapy  of  Cancer,"  Medical 
Record,  October  10,  1014. 

210 


OBSERVATIONS  AND  CONCLUSIONS 

first  employed  in  the  treatment  of  malignant  disease.  Elsewhere  in 
this  work  reference  has  been  made  to  X-ray  dermatitis,  or  skin  cancer, 
due  to  the  action  of  the  rays,  met  with  among  Roentgen-ray  workers.  In 
moderate  forms  of  cancer,  however,  the  application  of  X-rays  has  been 
beneficial  in  treatment,  but  the  statistical  data  are  far  from  suflScient 
and  conclusive.  The  discovery  of  radium  and  radio-activity  by  Mme. 
Curie  dates  from  1898-1900.  The  general  principles  of  radiotherapy 
have  been  elaborately  set  forth  in  a  work  by  Wickham  and  Degrais, 
translated  by  Dore,  with  an  introduction  by  Sir  Malcolm  Morris. 
The  therapeutic  results  discussed  in  the  work  are  illustrated  by  a  large 
number  of  colored  photographs  of  cases  before  and  after  treatment. 
Most  of  these  cases  represent  external  or  superficial  cancers,  and  but  a 
few  are  derived  from  gynecological  experience.  In  a  subsequent 
treatise  on  radium,  as  employed  in  the  treatment  of  cancer,  angiomata, 
keloids,  etc.,  the  same  authors  present  much  additional  evidence,  but 
again  most  of  the  illustrations  are  of  superficial  cutaneous  cancers,  which 
would  naturally  be  most  likely  to  yield  satisfactory  results. 

The  statistical  interpretation  of  the  facts  presented  by  these  and  other 
authors  on  radiotherapy  is  as  yet  far  from  convincing.  The  first  annual 
report  of  the  Radium  Institute,  published  in  the  British  Medical  Journal, 
under  date  of  January  25, 1913,  includes  657  cases,  but  of  these  a  large 
number  were  not  malignant  disease.  Of  the  carcinomata  and  sarcom- 
ata not  a  single  case  was  reported  as  cured ;  but  out  of  447  cases  treated, 
44,  or  9.8  per  cent.,  were  reported  as  apparently  cured;  137,  or  30.6 
per  cent.,  as  improved;  and  52,  or  11.6  per  cent.,  as  having  died. 

According  to  the  annual  report  of  the  London  Radium  Institute  for 
1913,  972  cases  were  treated  during  the  year,  of  which  548  were  cases 
of  malignant  disease.  Of  this  number  1  was  reported  as  cured,  but 
50,  or  9.1  per  cent.,  were  reported  as  apparently  cured;  181,  or  33  per 
cent.,  as  improved;  and  37,  or  6.8  per  cent.,  as  having  died. 

A  review  of  the  recorded  observations  on  individual  cases  warrants 
the  conclusion  that  radium  is  unquestionably  an  effective  method  of 
treatment  in  superficial  cancers,  particularly  in  the  earlier  stages  of  the 
disease.  The  results  of  the  treatment,  however,  are  largely  dependent 
upon  the  quantity  of  radium  used.  Failures  are  more  likely  to  be 
attributable  to  the  insufficiency  in  the  amount  of  radium  available 
than  to  any  other  cause,  at  least  in  patients  in  a  far-advanced  stage  of  the 
disease.  These  conclusions,  however,  apply,  as  yet,  almost  exclusively 
to  superficial  cutaneous  cancers,  which  cause  but  a  small  fraction  of  the 
aggregate  annual  loss  of  life.  There  has  not  been  sufficient  time  to 
observe  the  after-effects  of  radium  treatment  in  a  large  enough  number 
of  typical  cases.  The  statistical  experience  data  have  also  not  as  yet 
been  subjected  to  an  extended  critical  analysis,  with  a  due  regard 
to  the  organs  and  parts  of  the  body  affected  or  the  specific  types  of  the 
disease  and  the  degree  of  cancerous  involvement.  Nor  has  the  question 
of  joint  results  in  operative  and  radium  treatment  combined  received 
adequate  attention.  There  would  seem  to  be  much  ground  for  accept- 
ing the  conclusion  that  the  best  results,  at  least  in  internal  cancers,  are 
likely  to  be  obtained,  first,  by  surgical  interference,  and,  second,  by 
subsequent  radiotherapy. 

211 


THE  MORTALITY  FROM  CANCER 

The  practical  question  remains,  however,  as  to  where,  under  present 
conditions  the  required  amount  of  radium  is  to  be  obtained,  and  the  out- 
look is  far  from  encouraging  that  within  a  measurable  period  of  time 
there  will  be  sufficient  radium  for  proper  treatment,  even  in  the  principal 
centers  of  population.  The  hope  for  the  future  lies  in  the  efforts  now 
being  made  by  the  United  States  Bureau  of  Mines  to  develop  the 
carnotite  deposits  of  Colorado  and  Utah,  which,  it  is  to  be  hoped,  may- 
yield  a  sufficient  supply  for  general  use.* 

Need  of  an  Educational  Propaganda 

Within  the  last  few  years  the  conviction  has  been  gaining  ground  that 
the  cancer  problem  is  in  a  large  measure  a  public  question  of  increasing 
importance.  As  early  as  1891,  and  possibly  before.  Dr.  G.  Winter  of 
Konigsberg,  initiated  a  pubhc  campaign  for  the  education  of  the  general 
practitioner  and  the  laity  in  the  important  question  of  the  earhest  pos- 
sible recognition  of  symptoms,  diagnosis  and  qualified  treatment  of 
cancer  of  the  uterus.  The  principles  of  a  public  campaign  as  laid 
down  by  Winter  have  become  generally  adopted  in  similar  efforts 
inaugurated  in  other  countries,  not  only  in  regard  to  cancer  of  the  uterus, 
but  in  behalf  of  a  movement  for  the  control  of  cancer  in  any  and  all  of 
its  multitudinous  varieties.  The  cardinal  principles  advanced  by  Winter 
are,  in  brief,  (1)  the  ignorance  or  indifference  of  the  average  practitioner 
regarding  the  seriousness  of  the  first  symptoms  of  malignant  disease, 
(2)  the  ignorance  and  even  criminal  carelessness  of  midwives,  (3)  the 
criminal  practices  of  charlatans  in  advertising  cancer  cures  ;t  and  (4) 
the  ignorance  of  the  laity. 

A  full  discussion  of  the  development  of  the  educational  campaign 
would  carry  the  present  work  far  beyond  the  original  plan  and  scope 
of  a  concise  presentation  and  review  of  the  available  statistical  data 
regarding  cancer  frequency  throughout  the  world.  The  primary  purpose 
being  a  collection  of  trustworthy  statistical  data  essential  to  the  further- 
ance of  efforts  to  educate  the  general  practitioner  and  the  general  pubhc 
in  the  fundamental  facts  of  the  cancer  problem.  It  has,  however, 
seemed  appropriate  to  include  the  foUo^^dng  brief  outline  of  what  has 
thus  far  been  done  in  carrying  out  a  program  of  far-reaching  significance, 
not  only  to  the  medical  profession,  but,  in  fact,  to  the  adult  population 
of  every  civilized  country  in  the  world. 

Importance  of  Knowledge  of  Early  Symptoms  of  Cancer 

Suggestions  regarding  the  advantages  of  a  better  understanding  on  the 
part  of  the  general  public  of  the  essential  facts  of  the  cancer  problem 

*The  statistics  of  the  London  Radium  Institute  for  19 14  are  derived  from  the  abstract  printed  in  the  Novem- 
ber 14,  1914,  issue  of  the  Scientific  American  Supplement.  The  abstract  of  the  report  itself  is  to  be  found  in 
the  British  Medical  Journal,  February  27,  1914.  The  results  of  the  Radium  Investigations  of  the  Bureau 
of  Mines  are  contained  in  Bulletin  No.  70  of  the  series  of  reports  on  Mineral  Technology,  published  under  the 
direction  of  Charles  L.  Parsons,  Washington,  1913.  The  Hearings  on  Radium  before  the  Committee  on  Mines 
and  Mining,  held  on  Joint  Resolution  185-186,  were  published  as  a  Congressional  document,  Washington, 
1914.  The  report  of  the  Committee  was  issued  under  date  of  February  3,  1914,  and  is  published  as  Report 
No.  214,  House  of  Representatives,  63d  Congress,  2d  Session. 

tMisleading  advertbements  of  alleged  cancer  remedies  and  cancer  cures  are  unquestionably  the  means  of  a 
vast  amount  of  injury  to  the  public.  In  Great  Britain  the  subject  of  cancer  advertisements  was  investigated 
by  the  House  of  Commons,  through  a  Select  Committee  on  Patent  Medicines.  The  committee  made  its  report 
under  date  of  August  4,  1914,  and  recommended,  with  other  instructions,  "that  the  advertisement  and  sale 
(except  the  sale  by  a  doctor's  order)  of  medicines  purporting  to  cure  the  following  diseases  be  prohibited: 
cancer,  consumption,  deafness,  diabetes,  epilepsy,  etc." 

212 


OBSERVATIONS  AND  CONCLUSIONS 

have  been  made  from  time  to  time,  but  the  classical  effort  in  this  direc- 
tion is  the  work  of  Dr.  Georg  Winter,  who,  as  early  as  1891,  initiated  a 
public  campaign  against  cancer  of  the  uterus  in  East  Prussia.  In  an 
address  read  before  the  Mississippi  Valley  Medical  Association  in  1895, 
Dr.  Theodore  A.  McGraw,  after  pointing  out  that  a  society  called  "The 
League  Against  Cancer"  had  recently  been  formed  in  France  with  the 
object  of  instituting  a  crusade  against  malignant  disease,  concluded  with 
the  suggestion  that  "Physicians  should  be  better  instructed  in  the  means 
of  diagnosis  and  in  the  necessity  of  early  operative  treatment,  and  last, 
but  not  least,  the  laity  should  be  induced  to  assist  not  only  with  liberal 
contributions  of  means,  but  also  with  that  intelligent  cooperation  which 
would  lessen  our  diflBculties  in  collecting  evidence  and  making  post- 
mortems and  keeping  the  sufferers  out  of  the  hands  of  quacks."  Five 
years  later.  Dr.  Philander  A.  Harris,  in  a  brief  address  before  the  New 
York  Academy  of  Medicine,  gave  expression  to  the  view  that  "The 
profession  should  be  educated,  and  secondarily  the- people  should  become 
educated,  as  to  the  importance  of  early  operation."  Dr.  W.  L.  Rod- 
man of  Philadelphia,  in  a  paper  read  in  the  Section  on  Surgery  and 
Anatomy  of  the  American  Medical  Association,  July,  1905,  sug- 
gested that  "the  public  be  educated,  as  they  will  be  in  time,  to  believe 
that  an  early  diagnosis  and  prompt  operation  are  both  necessary." 
Dr.  Martin  of  New  Orleans,  in  discussing  the  paper  by  Dr.  Rodman, 
endorsed  his  view  by  suggesting  that  "Physicians  and  the  public  alike 
should  be  educated."  At  the  second  International  Cancer  Conference, 
held  in  Paris,  October,  1910,  Prof,  von  Czerny,  president  of  the 
International  Association  for  Cancer  Research,  laid  emphasis  on  the 
belief  that  "the  education  of  the  medical  profession  was  essential  to  the 
early  diagnosis  of  cancer."  Dr.  J.  C.  Bloodgood  in  an  address  on 
"The  Surgical  Treatment  of  Cutaneous  Malignant  Growths,"  read  in 
the  Section  on  Dermatology  of  the  American  Medical  Association, 
June,  1910,  reemphasized  this  suggestion  in  the  statement  that  it 
seemed  well  worth  while  "to  educate  the  public,  and  to  educate  the 
physician,"  and  that  both  "should  be  impressed  with  the  importance 
of  the  immediate  and  complete  removal  of  any  congenital  mole  showing 
evidence  of  growth,  superficial  ulceration,  or  scab  formation."  Dr.  J. 
H.  Jacobson  of  Toledo,  in  an  extended  address  on  "The  Results  Obtained 
by  the  Radical  Abdominal  Operation  for  Carcinoma  of  the  Uterus," 
concludes  that  "The  real  problems  at  the  present  time  in  the  treatment 
of  uterine  cancer  are  not  what  particular  operation  gives  the  best  results, 
but,  rather,  how  such  patients  can  be  operated  on  earlier  and  how  the 
primary  mortality  of  the  radical  abdominal  operation  can  be  further 
reduced.  The  first  problem  can  be  solved  only  by  a  campaign  of  educa- 
tion in  our  medical  schools  and  in  our  medical  societies,  together  with 
some  form  of  public  instruction  similar  to  that  which  has  been  inaug- 
urated in  Germany  by  Diihrssen  and  Winter."* 

*A3  early  as  1802  a  Society  for  Investigating  the  Nature  and  Cure  of  Cancer,  was  organized  in  London. 
Under  the  auspices  of  some  of  the  foremost  physicians  of  the  period  a  letter  of  inquiry  was  sent  out  to  the 
principal  physicians  of  England  containing  thirteen  questions,  in  regard  to  the  diagnostic  indications  of  cancer, 
the  pathological  and  anatomical  nature  of  cancer,  whether  a  primary  disease  or  a  transitional  pathological 
condition,  whether  inherited,  whether  infectious,  whether  related  to  other  diseases,  chiefly  scrofulous  and  syph- 
ilitic, whether  affected  by  climate  and  topography,  whether  affected  by  temperamental  predisposition, 
whether  met  with  among  animals,  etc.     (J.  Wolff,  Lehre  von  der  Krebskrankheit,  Vol.  i,  p.  81.) 

213 


THE  MORTALITY  FROM  CANCER 

Dr.  H.  J.  Boldt  of  New  York,  in  a  discussion  of  how  we  may  reduce 
the  mortahty  from  cancer  of  the  uterus,  with  special  reference  to 
treatment  and  to  pubhcity  through  the  lay  press,*  gives  the  weight  of 
his  endorsement  to  the  plan  of  public  education,  in  the  direction  of  the 
dissemination  of  knowledge  regarding  the  early  symptoms  of  cancer  of  the 
uterus  through  the  medium  of  the  newspapers  and  the  periodical  press. 
He  remarks  that  in  this  publicity  work,  if  undertaken  in  this  country, 
we  would  be  following  "in  the  footsteps  of  Germany,  where  the  dissemina- 
tion of  knowledge  by  similar  means  was  begun  by  Dtihrssen  of  Berlin  many 
years  ago,  and  later,  on  a  more  extensive  scale,  by  Winter  of  Konigsberg." 
He,  however,  suggests  that  "more  practical  benefits  would  be  gained  by 
impressing  upon  physicians  the  grave  risk  of  treating  with  internal  or 
local  medication,  before  having  made  sure  that  no  malignant  condition 
was  present,  a  patient  having  even  the  slightest  suspicious  symptom," 
and  he,  no  doubt,  is  entirely  sound  in  his  final  conclusion,  that  "The 
promulgation  of  knowledge  regarding  cancer  of  the  uterus  through  the 
lay  press,  as  advised  at  the  last  meeting  of  a  large  national  gathering, 
cannot  bring  about  a  lowering  of  mortality  from  uterine  cancer  to  such 
an  extent  as  would  be  the  case  if  the  medical  profession — the  family 
physician — did  the  teaching  directly." 

Dr.  Parker  Syms  of  New  York,  in  a  public  address  on  "The  Pre- 
vention and  Cure  of  Cancer,"t  also  remarks  that  "Most  of  our  teaching 
must  come  through  the  physician  in  his  practice.  If  that  were  well  done 
it  would  be  far  better  than  anything  that  could  be  done  otherwise  in  the 
way  of  spreading  knowledge  by  literature,"  but,  he  observes,  "there  are 
some  things  it  is  well  for  the  public  to  know.  It  is  well  for  them  to  know 
that  every  lump  and  every  swelling  is  more  or  less  suspicious;  they 
should  know  that  cancer  has  no  definite  characteristic  symptom  which 
distinguishes  it  from  other  conditions.  And  they  should  know,  also, 
that  a  physician  can  give  intelligent  advice  only  after  he  has  made  a  most 
careful  examination  in  any  case."  He  draws  attention  to  the  possibili- 
ties of  effective  aid  to  be  rendered  by  life  insurance  companies  by  the 
dissemination  of  knowledge  among  their  policyholders  as  to  how  to 
prevent  cancer.  He  concludes  that  a  public  campaign  "should  not  only 
be  nation  wide,  but  world  wide;  and  the  more  quickly  it  is  started  on  a 
uniform  basis  with  good  organization  the  more  quickly  will  it  become 
effective." 

In  an  address  before  the  New  York  Academy  of  Medicine,  May  15, 
1913,  Dr.  Willy  Meyer  of  New  York,  suggested  that  "The  public  should 
be  taught  the  early  signs  of  cancer,"  and  that  "It  is  to  be  hoped  that 
by  publicity  the  same  results  which  have  been  achieved  with  those 
afflicted  with  tuberculosis  may  be  obtained  in  patients  afflicted  with 
cancer."  In  an  address  read  before  the  American  Gynecological  Society, 
Washington,  D.  C,  May,  1913,  Dr.  F.  J.  Taussig  considers  the  best 
methods  of  educating  American  women  concerning  cancer,  advising  that 
physicians  should  be  the  prime  movers  in  the  organization  of  societies  for 
the  control  of  cancer,  but  that  the  educational  work  itself  should  be, 
as  in  the  case  of  tuberculosis,  left  largely  in  the  hands  of  the  laity.     He 

*  Journal  of  the  American  Medical  Association,  March  29, 1913. 
^Medical  Record,  May  17,  1913. 

214 


OBSERVATIONS  AND  CONCLUSIONS 

refers  to  the  fact  that  in  1904,  in  the  discussion  of  a  paper  by  Dr.  Samp- 
son, on  the  early  recognition  of  uterine  cancer,  he  had  advocated  that 
this  work  should  be  done  by  the  American  Medical  Association;  but  he 
had  come  to  the  conclusion  that  "the  organization  should  be  under  the 
control  of  the  laity,  and  only  the  direction  of  the  work  should  be  in  the 
hands  of  the  medical  profession." 

Dr.  W.  A.  Bryan  of  Nashville,  Tenn.,  in  the  chairman's  address  at 
the  public  session  of  the  Southern  Medical  Association,  Lexington,  Ky., 
November,  1913,  said  that  "There  is  a  far  greater  necessity  for  instruction 
of  the  laity  on  the  subject  of  cancer  than  of  the  medical  profession,  for 
in  the  vast  majority  of  cases  of  hopeless  cancer,  hopeless  because  of  delay, 
we  are  able  to  learn  that  the  physician's  patience  had  been  exhausted 
trying  to  convince  a  wilful  patient  of  the  necessity  for  action."  He 
adds  the  further  convincing  observation  that  "The  consent  [to  a  surgical 
operation]  usually  comes  after  the  disease  has  fulfilled  the  necessarily 
very  plain  requisites  to  satisfy  the  dull  diagnostic  abilities  of  the  patient 
himself.  He  [the  patient]  desired  interference  only  as  a  last  resort,  and 
last-resort  therapy  terminates  almost  uniformly  in  death.  The  layman 
must  learn  certain  things  he  does  not  know,  and  must  unlearn  much  that 
he  thinks  he  knows  before  his  part  in  the  cancer  problem  can  be 
performed." 

Public  Education  in  Methods  of  Cancer  Control 

The  first  comprehensive  statement  regarding  the  salient  facts  of  the 
cancer  problem  of  interest  and  importance  to  the  laity  is  a  treatise 
on  "The  Control  of  a  Scourge — How  Cancer  is  Curable,"  by  Charles  P. 
Childe,  F.  R.  C.  S.,  Surgeon  Royal  Portsmouth  Hospital,  England, 
published  in  the  New  Library  of  Medicine,  1906.  The  work  includes 
extended  consideration  of  the  conditions  under  which  cancer  is  curable . 
or  not,  with  observations  on  the  dread  of  operation,  the  first  danger- 
signals,  the  possibilities  of  prevention,  the  urgent  need  of  public  educa- 
tion, the  serious  menace  of  alleged  cancer  cures,  the  measurable  evidence 
of  a  considerable  degree  of  success  in  early  operative  treatment,  etc. 

A  similar  work  written  primarily  for  the  instruction  of  the  public, 
but  of  value,  also,  to  the  medical  profession,  is  a  small  treatise  on 
"Preventable  Cancer,"  by  Rollo  Russell,  published  in  London,  1912. 
The  work  includes  an  extended  statistical  survey  of  cancer  throughout 
the  world,  and  some  exceptionally  valuable  observations  on  the  relation 
of  diet  to  cancer  frequency,  the  temperature  of  food,  the  increase  of 
excessive  alimentation,  and  a  rough  outline  of  certain  supposed  factors 
accountable  for  cancer  occurrence.* 

Works  of  this  character  are  unquestionably  of  great  value  in  stimulat- 
ing the  development  of  an  intelligent  but  restrained  public  interest  in 

*Aiiiong  recent  educational  pamphlets  on  the  cancer  problem  published  in  the  furtherance  of  the  efforts  of 
the  American  Society  for  the  Control  of  Cancer,  mention  requires  to  be  made  of  the  following,  issued  by  the 
Council  on  Health  and  Public  Instruction  of  the  American  Medical  Association:  "Control  of  Cancer," 
Joseph  C.  Bloodgood,  "Cancer  of  the  Skin,"  Henry  H.  Hazen,  "Cancer  of  the  Womb,"  Franklin  H 
Martin,  "Cancer  of  the  Genito-Urinary  Organs,"  Hugh  H.  Young.  The  American  Society  for  the  Control 
of  Cancer  has  issued  two  suggestive  pamphlets,  "Cancer  as  a  Social  Problem"  and  "The  Role  of  the  Nurse  in 
the  Campaign  Against  Cancer,"  prepared  by  the  Executive  Secretary  of  the  Society,  Mr.  Curtis  E.  Lakeman. 
An  exceptionally  valuable  publication  made  available  for  nation-wide  distribution  has  been  issued  by  the 
Health  Education  League  of  Boston,  prepared  by  Dr.  Robert  B.  Greenough  of  the  Medical  School  of  Harvard 
University. 

215 


THE  MORTALITY  FROM  CANCER 

the  many  practical  questions  which  require  consideration  in  the  further- 
ance of  a  public  campaign  for  the  control  of  cancer :  the  arrest  of  the  per- 
sistent increase  ia  the  cancer  death  rate  and  the  ultimate  reduction 
of  the  appalling  mortality  from  malignant  disease.  It  is,  therefore, 
of  the  utmost  importance  that  a  movement  of  this  kind  should  be 
carried  forward  under  the  auspices  of  a  National  Society  for  the 
Control  of  Cancer,  directed  by  laymen,  physicians  and  surgeons  of 
established  reputation,  and  entitled  to  the  confidence  of  the  general 
public.  Following  the  public  discussion  of  the  menace  of  cancer  during 
the  early  part  of  1912,  the  American  Society  for  the  Control  of  Cancer 
was  formed  in  the  City  of  New  York,  on  May  22, 1913,  with  the  object, 
as  laid  down  in  the  constitution,  "To  disseminate  knowledge  concerning 
the  symptoms,  diagnosis,  treatment  and  prevention  of  cancer,  to  in- 
vestigate the  conditions  under  which  cancer  is  found  and  to  compile 
statistics  in  regard  thereto."  Under  the  auspices  of  this  society  many 
public  meetings  have  been  held  throughout  the  United  States,  under 
the  immediate  direction  of  local  committees  appointed  by  the  state  or 
county  medical  societies,  in  cooperation  with  influential  laymen  and 
laywomen  interested  in  the  cancer  cause.  The  Society  has  also 
been  instrumental  in  bringing  about  a  more  active  interest  on  the 
part  of  the  public-health  authorities  in  the  dissemination  of  general 
knowledge  regarding  cancer  symptoms,  diagnosis  and  treatment,  with 
the  result  that  there  has  been  a  vast  amount  of  publicity  of  salient  facts 
concerning  cancer  frequency,  diagnosis,  treatment  and  cure,  on  the  basis 
of  approved  principles  in  the  practice  of  medicine,  to  the  measurable 
benefit  of  the  public.  The  movement  has  the  hearty  endorsement  of  the 
principal  national  medical  and  surgical  associations,  and  the  active 
support  of  many  influential  lay  persons  throughout  the  nation.* 
•  It  has  therefore  seemed  appropriate  to  include  in  Appendix  H  a 
reprint  of  an  educational  circular  published  by  the  American  Society 
for  the  Control  of  Cancer,  and  widely  distributed  throughout  the 
country  in  the  furtherance  of  its  public  campaign.! 

In  this  direction,  then,  would  seem  to  lie  the  only  hope  of  cancer 
cure  and  cancer  control.  To  the  extent  that  the  public  at  large  be- 
comes thoroughly  cognizant  of  the  true  menace  of  malignant  disease, 
the  practical  possibilities  of  effective  control  become  self-evident. 
Understanding  alone,  not  mere  knowledge,  is  power;  and  a  thorough 
understanding  of  fundamental  principles,  methods  and  results  is  nowhere 
likely  to  prove  more  useful  and  far-reaching  than  in  the  vast  domain 
of  preventive  medicine   and  public  health.    The   difficulties    to    be 

*TabIes  3  and  4,  Appendix  H.  See  in  this  connection  the  Report  on  the  Health  of  Portsmouth  for  the  Year 
1913,  issued  during  the  early  part  of  1915,  pp.  34-37,  the  Report  on  the  Health  of  Rochdale  for  1913,  and  the 
Report  of  the  Metropolitan  Borough  of  Paddington  for  1913,  pp.  64-68.  According  to  the  annual  report  of 
Dr.  A.  M.  Fraser,  the  Medical  OflScer  of  Health  of  Portsmouth  for  1914,  there  were  only  197  deaths  from 
cancer  in  Portsmouth  during  that  year,  as  compared  with  230  in  1913.  It  is  pointed  out  in  this  connection 
that  "this  decrease,  which  occurs  in  the  face  of  an  increase  of  population,  is  hailed  with  satisfaction  by  the 
Portsmouth  sanitary  authorities  as  justifying  their  efforts  to  reduce  the  cancer  death  rate  by  persuading 
persons  who  are  attacked  with  this  disease  to  avoid  delay  and  to  seek  treatment  before  it  is  too  late  for  more 
than  palliative  measures."  Dr.  Fraser  also  reports  that  from  statements  made  to  him  by  local  medical  men 
the  publication  of  circulars  and  newspaper  articles  by  the  health  department  has  been  instrumental  in 
inducing  a  number  of  persons  suffering  from  early  operable  cancer  to  secure  treatment,  the  result  of  which,  it 
is  hoped,  will  be  permanent. 

fTables  1  and  2,  Appendix  H. 

216 


OBSERVATIONS  AND  CONCLUSIONS 

overcome  are  appalling;  but  the  objects  to  be  achieved  are  well  worthy 
of  the  most  strenuous  effort  and  the  not  inconsiderable  expense. 
Qualified  cancer  research  into  the  underlying  conditions  or  circum- 
stances accountable  for  the  occurrence  of  the  disease  must  needs  rank 
as  a  problem  of  the  first  order  of  importance  in  medicine  and  surgery; 
but  every  branch  of  science  related  thereto  should  derive  some  benefit 
from  the  statistical  evidence  brought  forward  in  this  work  for  the 
sole  purpose  of  facilitating  the  scientific  study  of  what  is,  what  ever 
has  been  and  what  is  ever  likely  to  remain  one  of  the  most  complex 
problems  of  human  life.  The  cause  of  cancer  control  also  should 
derive  some  direct  advantage  from  this  concise  and  comprehensive 
presentation  of  the  truly  colossal  loss  of  life  throughout  the  entire 
civilized  world  in  consequence  of  the  unchecked  ravages  of  malignant 
disease,  and  the  additional  and  indisputable  evidence  that  the 
disease  is  on  the  increase,  in  marked  and  significant  contrast  to 
the  decline  in  the  death  rate  from  practically  all  the  other  principal 
causes  of  death. 

Aside  from  humanitarian  motives,  which  in  the  furtherance  of  a 
policy  of  scientific  welfare  work  on  the  part  of  life  insurance  companies 
suggests  exhaustive  inquiries  of  this  kind,  there  are  the  strongest  pos- 
sible reasons  for  believing  that  a  nation-wide  campaign  for  the  control 
of  cancer  must,  in  the  process  of  time,  prove  of  direct  benefit  to  life 
insurance  policyholders,  as  well  as  to  the  public  at  large.  In  proportion 
as  such  efforts  are  successful,  it  is  obvious  that  encouragement  is  given 
to  similar  research  work  into  the  comparative  frequency  and  observed 
tendencies  of  other  diseases  more  or  less  within  the  range  of  prevention 
and  control. 

Future  Statistical  Research 

The  future  statistical  study  of  cancer  gives  promise  of  far-reaching 
results  of  great  practical  usefulness.  In  no  direction  are  such  results 
more  likely  to  be  valuable  than  in  the  standardized  tabulation  and 
critical  analysis  of  the  experience  data  of  large  hospitals  and  private 
clinics.  The  mere  publication  of  crude  and  superficially  considered 
data  is,  on  the  other  hand,  a  serious  menace  to  the  cancer  cause. 
Entirely  too  much  reliance  is  placed  upon  rates  or  percentages  derived 
from  a  small  number  of  cases,  and,  as  a  general  rule,  the  fundamental 
law  of  large  numbers,  which  underlies  all  qualified  statistical  analysis, 
is  completely  ignored.  The  value  of  many  an  important  contribution 
to  the  etiology  of  cancer  would  be  materially  increased  if  the  obser- 
vations were  made  to  rest  upon  a  larger  number  of  critically  considered 
individual  facts.  The  vast  amount  of  institutional  experience  obtain- 
able through  the  records  of  American  and  foreign  hospitals  is  at  present 
either  unavailable  or  published  in  a  form  more  or  less  useless  for 
practical  purposes.  The  correlation  value  of  such  data  to  the  natur- 
ally much  larger  amount  of  mortality  experience  derived  from  general 
or  life  insurance  sources  can  not  easily  be  exaggerated.  To  a  not 
inconsiderable  extent  the  future  of  qualified  cancer  research  depends 
upon  an  unimpeachable  statistical  basis. 

217 


TEE  MORTALITY  FROM  CAXCER 
Restatement  of  Conclusions  and  Results 

Mucli  if  not  most  of  the  available  statistical  information  regarding 
cancer  mortality  is  tentative,  and  trustworthy  only  in  an  approximate 
sense.  E:s;treme  caution  is  always  necessary  in  the  use  of  the  data;  but 
in  the  main  it  is  held  that  the  information  can  be  rehed  upon  to  justify 
broad  conclusions.  These,  in  brief,  as  deducible  from  the  statistical 
and  other  e\'idence  presented  in  this  work,  are  summarized  or  restated 
as  follows: 

The  first  chapter  presents  in  outhne  the  general  principles  of  statistical 
inquiry  and  emphasizes  the  practical  utiUty  of  the  statistical  method  in 
medicine  and  its  particular  appHcation  to  the  numerous  and  important 
general  aspects  of  the  cancer  problem.  Regardless  of  the  inherent  diffi- 
culties of  cancer  terminology^  exact  diagnosis  and  precise  classification, 
it  is  held  that  the  statistical  method  is  trustworthy  and  useful  for  the 
present  purpose,  and  in  the  main  at  least  approximately  conclusive 
regarding  local  cancer  frequency  and  the  observed  upward  tendency  of 
the  cancer  death  rate  throughout  the  civilized  world. 

In  the  second  chapter  the  statistical  basis  of  cancer  research  is  further 
considered,  and  the  need  of  an  even  more  exhaustive  study  than  the 
present  one  is  frankly  conceded  as  an  essential  requirement  for  a  full 
understanding  of  all  the  saHent  facts  of  the  cancer  problem.  The 
adoption  of  uniform  methods  of  tabulation  and  analysis  is  suggested  to 
registration  officials,  public  hospitals  and  life  insurance  companies  of  at 
least  the  more  important  countries  of  the  world;  but  even  under  existing 
statistical  hmitations  the  official  returns  for  some  twenty-six  per  cent, 
of  the  world's  population  have  been  utihzed  for  the  present  purpose.  It  is 
maintained  that  this  vast  amount  of  general  cancer  mortality  informa- 
tion is  in  sufficient  agreement  to  warrant  the  far-reaching  conclusion 
that  the  menace  of  cancer  throughout  the  civilized  world  is  much  more  serious 
than  has  generally  been  assumed  to  he  the  case. 

The  problem  of  cancer  increase  is  considered  in  some  detail  in  the  third 
chapter,  v»-ith  a  due  regard  to  the  ascertained  underlying  conditioning 
factors  determining  local  variations  in  the  death  rate  and  the  more  or 
less  controversial  arguments  as  to  the  apparent  or  actual  increase  in 
cancer  frequency  as  affected  to  a  variable  degree  by  serious  errors  in 
diagnosis  or  ob\'ious  mistakes  in  death  certffication.  The  conclusion  is 
advanced,  and  without  hesitation,  that  the  evidence  of  cancer  increase 
throughout  the  world  is  an  incontrovertible  statistical  fact,  and  absolutely 
conclusive;  and  it  is  maintained  further  that  arguments  to  the  contrary 
are  largely  in  the  nature  of  useless  controversies,  failing  conspicuously 
in  the  required  evidence  of  actual  errors  and  defects  in  the  original  data 
sufficient  in  number  to  invahdate  the  utility  of  the  returns  as  a  whole. 
It  is  held  in  this  connection  that  American  ^dtal  statistics  are 
strictly  comparable  with  the  mortality  statistics  of  European  and  other 
countries,  upon  the  assumption  that  absolute  accuracy  is  not  necessarily 
essential  to  the  present  purpose,  nor  attainable  under  any  conceivable 
existing  conditions,  also,  that  the  approximate  truth  as  revealed  hy  the 
present  investigation,  in  strict  conformity  to  the  law  of  large  nunibers, 
fully  justifies  the  conclusion  that  the  mortality  from  cancer  is  increasing  at 
a  more  or  less  alarming  rate  throughout  the  entire  civilized  world  and  that 

218 


OBSERVATIONS  AND  CONCLUSIONS 

this  increase  implies  most  serious  consequences,  present  and  future,  to  the 
populations  concerned. 

Preliminary  to  the  discussion  of  the  statistical  evidence  in  general,  the 
mortality  from  cancer  in  different  occupations  is  presented  in  the  fourth 
chapter,  and  amplified  with  numerous  interesting  and  suggestive  illus- 
trations of  exceptional  cancer  frequency  in  particular  employments. 
It  is  readily  conceded  that  at  the  present  time  the  available  cancer 
statistics  by  occupations  are  of  rather  limited  practical  utility;  but  it  is 
suggested  that  thoroughly  qualified  and  highly  specialized  inquiries  in 
this  direction  are  quite  certain  to  yield  important  results. 

Cancer  as  a  problem  of  life  insurance  medicine  is  discussed  at  some 
length  in  the  fifth  chapter,  with  a  brief  historical  survey  of  the  mortality 
from  malignant  disease  in  the  experience  of  life  insurance  companies 
throughout  the  world.  The  data  presented  fully  sustain  the  general 
conclusion  that  cancer  is  a  much  more  serious  mortality  problem  than  has 
generally  been  assumed  to  be  tbe  case,  and  that  without  question  the 
disease  is  on  the  increase  among  life  insurance  policyholders,  medically 
selected,  as  well  as  among  the  population  at  large.  Of  interest  in  this 
connection  are  the  suggestive  results  of  the  Medico- Actuarial  Investiga- 
tion, especially  as  regards  the  influence  of  overweight  on  the  cancer 
death  rate,  the  negative  evidence  regarding  the  influence  of  heredity  or 
family  history,  and,  finally,  the  important  modifications  in  the  cancer 
death  rate  resulting  from  marital  or  conjugal  condition. 

The  geographical  incidence  of  cancer  throughout  the  world  is  briefly 
reviewed  in  the  sixth  chapter,  with  some  consideration  of  related  diseases, 
such  as  biliary  calculi  and  non-malignant  tumors  of  the  uterus  and 
ovaries.  The  comparative  statistics  of  cancer  by  specified  organs  and 
parts  for  selected  countries,  for  which  the  returns  are  of  approximately 
the  same  degree  of  intrinsic  trustworthiness,  leave  no  room  for  any  other 
conclusion  than  that  practically  all  forms  of  cancer  are  on  the  increase,  but 
naturally  to  quite  a  variable  degree.  An  international  comparison  of 
crude  cancer  death  rates  for  the  period  1908-12,  based  upon  the  oflicial 
returns  of  more  than  one  and  a  half  million  deaths  for  the  five  continents 
combined,  indicates  with  approximate  accuracy  that  the  highest  cancer 
death  rate  prevails  in  Europe  and  that  the  lowest  rate  prevails  on  the 
continent  of  Africa.  Cancer  mortality  is  exceptionally  high  in  Switzer- 
land, Bavaria  and  Holland,  and  extremely  rare  among  North  American 
Indians  and  the  primitive  races  of  Asia  and  Africa. 

The  returns  for  American  states  and  cities  are  presented  in  some  detail 
in  the  seventh  chapter,  and  the  corresponding  data  for  foreign  countries 
are  discussed  in  chapter  eight.  There  is  included  in  these  two  chapters 
a  brief  consideration  of  cancer  frequency  as  modified  by  latitude,  size  of 
cities  and  climatic  conditions,  seemingly  warranting  the  conclusion  that 
cancer  frequency  decreases  with  diminishing  distances  from  the  equator,  or, 
what  is  practically  the  equivalent  thereof,  a  rise  in  cancer  mortality  is 
observed  to  occur  with  a  diminishing  mean  annual  temperature  and 
rainfall. 

In  the  ninth  and  concluding  chapter  a  variety  of  aspects  of  the  cancer 
problem  are  briefly  considered  for  the  purpose  of  facilitating  the  practical 
use  and  correct  interpretation  of  the  numerous  statistical  tables  and 

219 


THE  MORTALITY  FROM  CANCER 

forms  in  the  appendices.  The  primary  object  of  this  discussion  is  to 
illustrate  the  extremely  complex  nature  of  the  cancer  problem  and  the 
more  or  less  determining  influence  of  widely  different  and  constantly 
varying  special  factors  and  local  conditions.  The  extreme  rarity  of 
cancer  among  primitive  races,  such  as  the  North  American  Indian,  and 
the  relative  infrequency  of  special  forms  of  cancer  among  certain  types 
of  mankind,  such  as  the  comparative  freedom  from  cancer  of  the  breast 
of  Japanese  women,  are  brought  forward  as  proof  that  even  a  very 
low  cancer  death  rate  is  not  necessarily  evidence  of  the  intrinsic  untrust- 
worthiness  of  the  returns. 

These  illustrations  also  throw  much  light  upon  the  broader  aspects  of 
the  problem  of  cancer  causation,  or,  in  a  more  limited  sense,  the  con- 
ditioning circumstances  which  more  or  less  determine  the  local  degree  of 
cancer  frequency  in  different  countries  and  locaHties  of  the  civilized 
world.  Precancerous  conditions  are  considered  at  some  length,  and  it  is 
suggested  that  a  more  extended  study  should  be  made  of  the  coincident 
occurrence  of  cancer  and  other  diseases,  chiefly  gall-stones,  syphilis, 
leprosy,  rheumatism,  gout,  appendicitis,  diabetes  and  tuberculosis.  The 
surgical  aspects  are  briefly  discussed,  and  with  special  reference  to  the  at 
present  inadequate  statistics  of  cancer  hospitals,  which  are  most  urgently 
in  need  of  standardization,  so  as  to  facilitate  the  comparative  study  of 
the  results  of  institutional  treatment.  It  is  furthermore  suggested  that 
the  subject  of  post-operative  results  should  receive  qualified  statistical 
consideration,  in  that  most  of  the  available  data  are  at  present  of 
doubtful  intrinsic  trustworthiness.  The  same  considerations  apply  to 
the  problem  of  recurrence,  the  average  duration  of  the  disease,  the  rela- 
tive degree  of  mahgnancy  and  the  rapidity  of  growth.  All  of  these  are 
important  practical  aspects  of  the  general  cancer  problem,  whether 
medicaUy  or  surgically  considered.  With  regard  to  heredity  and  family 
history,  some  additional  observations  reemphasize  earlier  conclusions 
that  the  available  evidence  in  this  respect  is  in  the  negative.  The  rela- 
tion of  cancer  frequency  to  overnutrition,  metaboHc  disorders,  vege- 
tarianism and  diet  in  general  suggests  the  correlation  of  cancer  frequency 
to  overnutrition,  as  best  iflustrated  by  the  statistical  evidence  derived 
from  the  results  of  the  Medico-Actuarial  Investigation,  that  cancer  is 
more  common  among  overweights  than  among  underweights.  Chronic 
irritation  as  an  immediate  factor  of  cancer  causation,  first  considered  with 
reference  to  occupation,  in  another  chapter,  is  here  further  discussed 
with  regard  to  alcohol  and  smoking.  The  available  statistical  data 
would  seem  to  indicate  that  both  alcohol  and  smoking  are  directly 
contributory  factors,  to  a  variable  degree,  and  particularly  so  as  regards 
certain  organs  or  parts  of  the  body  affected.  The  extremely  important 
question  as  to  whether  cancer  is  of  a  parasitical  origin,  and  therefore 
possibly  an  infectious  disease,  is  considered  at  some  length,  with  especial 
reference  to  alleged  cancer  houses,  streets,  viflages,  etc.  The  available 
evidence  as  regards  a  possible  parasitical  origin  of  cancer  is  held  to  be  in- 
conclusive. This  point  is  sustained  by  the  vast  surgical  experience  which 
is  without  a  single  record  of  surgical  infection  in  cancer  operations.  The 
available  data  are  also  negative  on  the  alleged  causation  of  cancer 
by  worry  or  its  correlation  to  insanity.    Though  partly  outside  of  the 

220 


OBSERVATIONS  AND  CONCLUSIONS 

general  study  of  the  subject  from  the  statistical  point  of  view,  the  modem 
theories  of  radium  and  radiotherapy  are  briefly  referred  to,  with  special 
reference  to  the  statistical  experience  data  of  the  London  Radium  Insti- 
tute. The  outlook  is  encouraging  that  as  regards  external  cancers  the 
radium  treatment  of  the  future  will  prove  productive  of  much  more 
satisfactory  results  than  the  treatment  of  the  past.  As  regards  the 
effective  and  exclusive  use  of  radium  in  the  treatment  of  internal  can- 
cers the  evidence  at  present  is  quite  contradictory  and  inconclusive. 

Reviewing  the  aggregate  results  of  the  present  investigation,  it  is 
shown  that  cancer  is  much  more  common  than  has  generally  been 
assumed  to  be  the  case;  that  the  mortahty  from  the  disease  throughout 
the  civilized  world  exceeds  500,000  per  annum,  and  in  the  United  States 
about  80,000  at  the  present  time;  that  the  disease  is  increasing  in  practi- 
cally all  civilized  countries  and  as  a  general  rule  in  all  its  principal  forms 
or  varieties,  and  that  it  is  therefore  strictly  within  the  hmits  of  scientific 
conjecture  that  a  further  rise  in  the  death  rate  may  be  anticipated, 
unless  the  disease  is  made  subject  to  more  effective  methods  of  treat- 
ment and  control.  The  attainment  of  this  purpose  can  be  brought  about 
only  by  arousing  a  world-wide  interest  in  the  problem  of  cancer  control, 
rather  than  in  the  strictly  scientific  aspects  of  cancer  causation,  and  the 
development  of  a  sound  public  understanding  of  the  imperative  necessity 
of  early  surgical  and  possibly  other  interference  in  place  of  blind  rehance 
upon  more  or  less  disappointing  methods  of  treatment  by  other  means.  All 
of  these  and  many  other  more  or  less  controversial  aspects  of  the  cancer 
problem  urgently  suggest  the  broadening  of  the  scope  of  statistical 
research  and  the  perfection  of  methods  of  statistical  inquiry,  towards 
the  end  that  the  whole  truth  of  the  cancer  problem  may  be  revealed  to 
the  immeasurable  advantage  of  the  human  race. 


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APPENDIX 

A 

Tumor  Classifications 


Table  Page 

1  Walshe's  Classification,  1844 268 

2  Pembrey  and  Ritchie's  Classification,  1913 269 

3  Hatch's  Classification,  1904 271 

4  Charles  Powell  White's  Classification,  1913 272 

5  Gould  and  Pyle's  Classification,  1914 273 

6  Bertillon  International  Classification  of  Tumors 276 

7  Bertillon  International  Classification  of  Diseases  Allied  to  Tumors 281 

8  Imperial  Cancer  Research  Fund  Classification,  1903 283 


267 


APPENDIX  A 


w 

<a 

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m 

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o 

a 
>> 

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o 

fi 

Spongy  or  ossivorous  tumor.  Ruysch.  Pal- 

letta. 
Struma  fungosa  (testis).     Callisen. 
Spongoid  inflammation.     Burns. 
Milt-like  tumor.     Munro. 
Medullary  sarcoma.     Abernethy. 
Cerebriform  disease  or  cancer.     Laennec. 
Pulpy  testicle.     Baillie. 
Carcinus  spongiosus.     Good. 
Carcinoma  spongiosum.     Young. 
Fungoid  disease.     A.  Cooper,  Hodgkin. 
Medullary  fungus.     Maunoir,  Chelius. 
Acute  fungous  tumor.     C.  Bell. 
Medullary  cancer.     Travers. 
Cephaloma.     Hooper,  Carswell. 
Carcinoma  medullare.     Mueller. 
Soft  cancer.     Auct.  Var. 

Carcinomatous  sarcoma.     Abernethy. 
Carcinoma  scirrhosum.     Young. 
Scirrhous  cancer.     Travers. 
Scirrhoma.     Carswell. 
Carcinoma  simplex  vel  fibrosum.  Mueller. 
Stone  cancer.     Auct.  Var. 

Areolar  gelatiniform  cancer.  Cruveilhier. 
Carcinoma  alveolare.     Mueller. 
Gum  cancer.     Hodgkin. 

Common  vascular  1 

sarcoma           1  Abernethy. 
Mammary   sarco-  ( 

ma?                  j 
Solanoid.     Recamier,  Zang. 
Nephroid.     Idem. 
Napiform.     Idem. 
Carcinoma  fasciculatum  vel  hya- 

linum.     Mueller. 
Fungus  hsematodes.     Hey. 
Hsematode  Cancer.    Auct. Gall. 

§  ^  is 

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[  Pultaceous  cancer  ] 
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2()8 


APPENDIX  A 

Table  2 
Pembrey  and  Ritchie's  Classification,  1913 


A.  TUMOURS  ORIGINATING  IN  POST-NATAL  LIFE  FROM  NORMAL  TISSUES 

OF  INDIVIDUAL 


Innocent  Tumours 


Intermediate  Types 


Malignant  Tumours 


1.  Epiblast: 
Skin  epithelium 


Specialized  epi- 
blastic  structures 
(e.  g.,  breast): 

Skin    epithelium 

Pigmented  epi- 
thelial structures 

Nerve  tissue 

Germinal  epithe- 
lium 

2.  Mesoblast: 
Connective    tissue 


Primitive  connec- 
tive tissue 

Fat 

Specialized  meso- 
blastic  structures: 
Pigmented  cells 

Bone 


Cartilage 
Muscle 

Lymph  spaces 
Lymphatic  tissue 
and    blood-form- 
ing organs 

Hypoblast: 
Intestinal  mucosa 

Special  hypoblas- 
tic  organs  {liver, 
pancreas,  thyroid, 
etc.) 


Papilloma 


Adenoma 


Glioma 
Ovarian  cyst 


Fibroma 


Myeloid  sarcoma 
Myxoma 


Lipoma 


Certain  pigmented 
tumours  in  animals 

Osteoma :  ebumat- 
ed  (adamanti- 
noma), cancel- 
lous; odontoma 

Chondroma 

Leiomyoma  (fibro- 
myoma) 

Lymphoma 
Myeloma 


Hypoblastic  papil- 
loma 
Adenoma 


Simple  cystic  epi- 
thelioma 
Rodent  ulcer 
Basal-celled     car- 


Adenoma 


Proliferating  pap- 
illoma of  ovary 


Keloid 
Recurrent  fibroma 


Endothelioma 
?  Certain    cutane- 
ous sarcomata 


EpitheUoma. 


Carcinoma. 
Melanotic  carcinoma 

Gliosarcoma. 
Carcinoma  of  ovary. 


Sarcoma: 

Spindle-celled. 

Round-celled. 

Small  round-celled. 

Large  round-celled. 

Mixed-celled. 
Myeloid  sarcoma. 
Myxosarcoma. 


Melanotic  sarcoma. 
Osteosarcoma. 

Chondrosarcoma. 


Endothelioma. 
Lymphosarcoma. 
Chioroma. 
Leukaemia. 


Malignant  adenoma, 

carcinoma. 
Carcinoma. 


269 


APPENDIX  A 

Table  2  (concluded) 
Pembrey  and  Ritchie's  Classification,  1913 


B.    TUMOURS  ARISING  FROM  ERRORS  OF  DEVELOPMENT 

Group  1. — ^Tumours  arising  from  junction  of  two  embryos  or  from  a  process  analogous  to 
formation  of  monochorial  twins — in  either  case  from  cells  usually  having  the  capacity 
of  forming  more  than  one  embryonic  layer. 

From,  Somatoblast:  Includes  many  varieties  from  (a)  union  of  two  more  or  less  perfect 
individuals — e.  g.,  Siamese  twins — to  (b)  one  complete  individual  plus  elements 
of  another  (teratoid  dermoid  cysts,  teratoma). 

From  Trophoblast:  Chorionepithelioma  arising  in  an  otherwise  perfect maleorfemale. 

From,  Combined  Somatoblast  and  Trophoblast:  Usual  form — dermoid  cyst  plus 
chorionepithelioma. 

Group  2. — Tumours  arising  in  later  embryonic  life  from  displacement  of  cells  which  usually 
are  already  so  far  differentiated  as  to  be  capable  of  forming  only  one  type  of  adult 
tissue. 


Innocent  Tumours 

Intermediate  Types 

Malignant  Tumours 

From  epiblast 

Inclusion  dermoid 

__ 

Malignant  develop- 

cysts 

ments  in  dermoid 
cysts,  branchial 
clefts  or  other  epi- 
thelial    embryonic 
remains. 

Special  organs 

?  Suprarenal  rests 

— 

?  Suprarenal  rests. 

Neurocytoma 

— 

— 

Neurofibrilloma 

— 

— 

From  mesoblast: 

Bone 

Osteoma 

— 

— 

Cartilage 

Chondroma    (par- 
otid, testicle) 

— 

— 

Muscle 

Rhabdomyoma 
(heart,  kidney) 

— 

— 

Bloodvessels    . 

Angeioma 

— 

Angeiosarcoma. 

Lymphatic  vessels 

Lymphangioma 

— 

Lymphangeiosar- 
coma. 

Mixed  mesoblastic 

— 

Certain  kidney 

— 

elements 

tumours 

From  combined  epi- 

Nsevi (moles) 

Mixed  tumours  of 

Epithelioma  1 

devel- 
oping 
from 

blast  and  mesoblast 

parotid 

Melanotic 

sarcoma 

Melanotic 

nsevi. 

carcinoma 

C.    PARASITIC   TUMOURS  ARISING  FROM   TISSUE   OF   EMBRYO    BEING 
GRAFTED  ON  MATERNAL  ORGANISM 


Innocent  Tumour 

Intermediate  Type 

Malignant  Tumour 

Placental  mole 

Chorionepithelioma 

Chorionepithelioma 

270 


APPENDIX  A 

Table  3 
Hatch's  Classification,  1904 


THE  TUMORS  AS  DISTRIBUTED  AMONG  THE  FIVE  PATHOLOGICAL 
BLASTODERMIC  REGIONS  OF  THE  BODY 

I.  Epiblast. — Epithelial  hypertrophies, 
(corns,  horns  onychoma)  dermoids,  papil- 
loma adenoma,  papillary  adenoma,  hy- 
groma, odontoma,  lupus,  squamous  epithe- 
lioma; with  exception  of  Cancer  of  Breast, 
all  benign  and  non-metastatic. 


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^  Benign    or    non- 
metastatic. 


II.  Parietalor  Bodily  Mesoblast. — 
All  (benign)  tumors  of  connective  tissue 
substances,  viz. :  fibroma,  lipoma,  myxoma, 
osteoma,  chondroma,  osteoid  chondroma, 
neuroma,  and  the  non-metastatic  sarcom- 
ata (myeloid  and  both  forms  of  spindle- 
celled  sarcoma  and  glioma) .     (See  foot-note.) 

III.  Genito  -  Urinary  Mesoblast. — 
Leiomyoma,  rhabdomyoma,  myofibroma, 
cysticadenoma,  ovarian  cysts,  sarcomata 
of  various  kinds  and  tubercle,  but  all  non- 
metastatics  in  this  region. 

IV.  Visceral  Mesoblast.  —  Angioma, 
lymph-angiomaandlymphoma(suspicious); 
generalized  sarcomata  (melanotic)  alveolar, 
lymph-adenoid,  and  round-celled,  and 
tubercle;  all  malignant  and  metastatic, 
except  the  two  congenital  new-formations, 
viz. :  angioma  and  lymph-angioma. 

V.  Hypoblast.  —  Adenoma  and  cysts 
(suspicious)  cancers,  viz. :  cylindrical  epithe- 
lioma, soft  and  hard  cancers,  very  malig- 
nant and  metastatic  unless  they  become 
colloid;  (no  papilloma  in  this  region). 


Benign     or     non- 
metastatic. 


Benign  or  non- 
metastatic 
(even  tubercle 
is  so  in  this  re- 
gion, viz. :  usu- 
ally local). 


(Home  of  Tuber- 
cle) Malignant 
generalized  and 
metastatic 
tumors. 


Malignant       and 
metastatic. 


From  the  above  it  may  be  also  fairly  suggested  that  the 
visceral  mesoblast  originated  from  the  hypoblast. 

(Foot-note).  The  round  cells  sarcomata  apparently  found  in  this  region  do  not  strictly 
belong  to  this  region,  but  to  portions  of  the  visceral  mesoblast,  which  are  surrounded  or 
covered  by  the  parietal  mesoblast,  as  in  lymph-glands  and  vascular  system. 

271 


APPENDIX  A 

Table  4 
Charles  PoweU  White's  Classification,  1913 


CLASSIFICATION  OF  TUMOURS 

A.  Organomata,  or  Organ  Tumours. 
1.  Teratoma. 

B.  HiSTiOMATA,  or  Tissue  Tmnours. 

a.  Desmomata,  or  Supporting  Tissue  Tumours. 

1.  Myxoma.  Mucous  tissue. 

2.  Fibroma.  Fibrous  tissue. 

3.  Lipoma.  Fat. 

4.  Chondroma.  Cartilage. 

5.  Chordoma.  Notochordal  tissue. 

6.  Osteoma.  Bone. 

7.  Odontoma.  Dentine. 

8.  Glioma.  Neuroglia. 

h.  Neuromata,  or  Nerve  Tumours. 

1 .  Neuroma.  Nervous  tissue. 

c.  Myomata,  or  Muscle  Tumours. 

1.  Rhabdomyoma.  Striated  muscle. 

2.  Leiomyoma.  Smooth  muscle. 

d.  Lymphomata,  or  Lymphoid  Tissue  Tumours. 

1.  Lymphoma.  Lymphoid  tissue. 

2.  Myeloma.  Bone  marrow. 

e.  Epithelial  and  Endothelial  Histiomata. 

Papilloma,  Adenoma,  Angeioma. 

C.     Cytomata,  or  Cell  Tumours. 

a.  Blastocytomata.  Indifferent  cells. 

h.  Sarcomata  (Desmocytomata).  Supporting  tissue  cells. 

c.  Neurocytomata.  Nerve  cells. 

d.  Myocytomata.  Muscle  cells. 

e.  Lymphocytomata.  Lymphoid  cells. 

/.   Carcinomata.  Epithelial    and    endo- 

thehal  cells. 

272 


APPENDIX  A 

Table  5 

Gould  and  Pyle's  Classification,  1914 

TUMORS,  TABLE  OF 


Name 

Histologic  Constituents 

Physicai.  Manifestations 

Seats  of  Predilection 

Adenoma 

1.  Acinout 

2.  TuhuUiT 

Acini    lined    with    spheroidal 
epithelium,      with      varying 
amount  of  connective  tissue, 
as  in  a  normal  gland. 

Tubules  lined  with  cylindrical 
epithelium. 

Firm,  rather  hard  consistence; 
inelastic;     lobulated;     light- 
gray  or  slightly  yellow  color; 
movable;  encapsulated;  gen- 
erally single;  rounded;  when 
on  mucous  surfaces,  flat  and 
irregular. 

Soft;  frequently  pedunculat- 
ed; grayish- white  or  reddish 
color;  translucent. 

Mamma,  lip,  ovary,  testis, 
prostate,  thyroid,  parotid, 
lacrimal  gland,  sudoriferous 
and  sebaceous  glands. 

Rectum  and  other  portions 
of  intestines;  uterus. 

Angioma 

1.  Telangiectatic 

2.  Cavernous 

Dilated  blood-vessels. 

Spaces  lined  with  endothelial 
cells  and  filled  with  blood, 
like    corpora    cavernosa    of 
penis. 

Large  epithelial  cells  contain- 
ing one  or  more  nuclei,  with- 
out visible  intercellular  ma- 
trix, grouped  into  acini  (can- 
cer-nests).   Vessels  have  walls 
of  normal  thickness  and  con- 
stitution, and  ramify  in  the 
stroma,  and  not  among  the 
cells  themselves. 

Three  varieties  are  described 
histologically:  (a)  squamous, 
made  up  of  squamous  or  flat 
epithelium;    (6)    cylindrical, 
containing  columnar  cells;  (c) 
glandular,  composed  largely 
of  polyhedral  cells,  like  those 
of  secreting  glands. 

A  form  of  round-celled  sar- 
coma {which  see). 

Surface   often    covered    with 
small,    granular    elevations, 
resembling     a     strawberry; 
often  well  circumscribed. 

Soft,  doughy;    non-pulsating; 
leaden  or  blue  color. 

Skin,  mucous  membrane, 
brain,  bones  and  mamma. 

Liver,  kidney,  spleen,  uterus, 
bones,  muscle. 

Carcinoma 

1.  Scirrhous       (hard, 
spheroidal-celled) 

2.  Encepkaloid   (soft, 
spheroidal-celled) 

3.  Colloid    (probably 
a  degeneration  of 
one  of  the  preced- 
ing varieti<!s) 

Hard,  irregular,  tuberous;  ad- 
herent  to    surrounding   tis- 
sues; ulcerated.   Non-encap- 
sulated.       Ulcer. — Irregular 
in  outline  and  depth;  margins 
hard,  nodular,  everted. 

Soft,  globular,  or  bossellated; 
elastic,    compressible;    fluc- 
tuating;  non-encapsulated. 

Soft;  jelly-like;  contains  mu- 
coid material;     semitranslu- 
cent;    glistening;    at    places 
diffluent. 

Mamma;  alimentary  tract 
(especially  the  pyloric  end  of 
stomach);  glands  of  the  skin 
(rare);  rectum;  uterus. 

Testicle;  ovary;  mucous  mem- 
branes. 

Stomach;  intestine;  ovary; 
mamma;  thyroid. 

Chloroma 

Small  nodules. 

Periosteum  of  skull. 

Cholesteatoma 

Concentric  layers  formed  of 
flat    cells    of    an    epithelial 
character,  arranged  in  whorls 
enclosing  cholesterin  plates. 
Belongs    probably    to    the 
Teratomata  from  the  occur- 
rence   in    it    of    sebaceous 
glands,  hair-follicles,  etc. 

Hyaline     or     fibro-cartilage, 
with  few  blood-vessels.    The 
cells  are  arranged  irregularly 
and  have  irregular  shapes, 
many  being  stellate  or  spin- 
dle-shaped. 

Multiplication  of  endothelial 
cells  lining  lymph-passages. 
A  variety  of  sarcoma.  Large, 
round   cells   containing   one 
or   two    nuclei.      Resembles 
epithelial  new-growths. 

Solitary  or  multiple  nodules 
or  nodes. 

Brain  and  meninges. 

Chondroma 

(Enchondroma) 

Hard;  elastic;  nodular  or  lobu- 
lated,    sometimes     smooth; 
round;  encapsulated;  usually 
single,  but  may  be  multiple 
and  symmetric. 

The  bones,  especially  on  or  in, 
the  phalanges;  scapula,  ilium, 
upper  jaw;  subcutaneous  tis- 
sue; salivary  glands  (parot- 
id); testicle;  bronchial  car- 
tilages. 

Endothelioma 

Circumscribed    or    extensive 
flat  growths,  spreading  over 
the  serous  membranes;  white 
in  color. 

Pleura  and  peritoneum;  mem 
branes  of  brain. 

273 


APPENDIX  A 

Table  5  (continued) 
Gould  and  Pyle's  Classification,  1914 
TUMORS,  TABLE  OF 


Name 

Histologic  Constituents 

Physical  Manifestations 

Skats  of  Predilection 

Epithelioma 

1.  Squamous 

2.  Cylindric-celled  or 
colu  mnar-celled 

Composed  of  pegs  or  columns 
of    cuboidal    epithelial  cells 
which  first  infiltrate  the  sub- 
jacent connective  tissue,  then 
every  underlying  structure, 
including  bone,  in  their  track. 
These  ingrowths  contain  the 
cell-nests,    epidermal    pearls, 
or  pearly  bodies. 

Originates    either    from    the 
cylindric   surface-epithelium 
of  a  mucous  membrane,  or 
from  that  of  glands  lined  by 
columnar  epithelium.    Con- 
tains no  "cell-nests."    Con- 
sists   of   alveoli    containing 
cylindric  cells  at  the  periph- 
ery, and  irregular    cells    in 
the    center.      Presents    the 
character      of      adenocarci- 
noma. 

Dense;    inelastic;   non-encap- 
sulated; ulcerated;  edges  of 
ulcer  indurated. 

Soft,    infiltrating    masses    or 
nodes,       or      papillomatous 
growths. 

Nose,  lower  lip,  penis,  scro- 
tum, vulva,  anus,  tongue, 
gums,  palate,  tonsils,  larynx, 
pharynx,  esophagus,  bladder, 
or  uterus,  hands  and  feet 
(rare). 

Stomach;  intestinal  tract; 
uterus;  gall-bladder;  biliary 
passages;   respiratory  tract. 

Fibroma 

1.  Hard 

i.  Soft 

White,  fibrous  tissue,  consist- 
ing of  fibers  and  few  connec- 
tive tissue  corpuscles;  blood- 
vessels few. 

Few  fibers,  many  cells. 

Ovoidal    or    spherical;    lobu- 
lated;  nodular  or  bossellated; 
pedunculated  or  sessile;  firm, 
elastic;    encapsulated;    glis- 
tening  white,  yellowish,   or 
slightly  red  color;  unattached 
to  overlying  tissues;   single 
or  multiple. 

Soft,  compressible;  sessile  or 
pendulous;  single  or  multi- 
ple; encapsulated. 

Soft,      gelatinous,^     glue-like 
tumor;    not   distinctly   out- 
lined; somewhat  translucent. 
Usually  single. 

Uterus;  periosteum;  ovary; 
labium  majus;  mamma;  tes- 
ticle; tendons;  aponeurosis; 
neurilemma  of  nerves;  around 
articulations;  subcutaneous 
tissue;  rectum. 

Glioma 

Round  cells,  with  large  nuclei, 
embedded  in  a  scanty,  granu- 
lar,  intercellular  substance. 
After  the  type  of  the  neurog- 
lia of  the  brain. 

Brain;  retina;  spinal  cord; 
optic  and  auditory  nerves; 
suprarenal  capsules. 

Lipoma 

Adipose    tissue     (fat-vesicles 
larger  than  normal)  bound 
together  by  delicate  connec- 
tive tissue. 

Circumscribed;  lobulated,  soft, 
doughy,  pseudo-fluctuating, 
inelastic;    attached    to    the 
skin — hence  dimpled;  ovoi- 
dal, spherical,  or  flattened; 
occasionally     pedunculated; 
usually  surrounded  by  a  thin 
capsule;  usually  single;  when 
multiple,  usually  hereditary. 

Soft,  doughy,  transparent  sacs 
or  vesicles,  filled  with  lymph; 
often  feels  like  a  series  of 
tangled  cords. 

Back  of  neck;  shoulders;  back; 
nates;  inside  of  arm  and 
thigh;  submucous  and  sub- 
serous connective  tissue. 

Lymphangioma 

Aggregation  of  dilated  lym- 
phatic  vessels   and   lymph- 
spaces  supported  by  connec- 
tive tissue. 

Posterior  and  inner  surfaces 
of  thigh,  genitals;  anterior 
abdominal  wall;  neck,  nates, 
axilla,  groin,  penis,  tongue, 
cheeks,  lips,  liver,  kidney. 

Lympho-sarcoma 

Hyperplasia  of  the  lymphoid 
cells  of  the  lymphatic  glands. 

Glands  for  a  time  preserve 
their   shape,    but   soon   ex- 
tends to  neighboring  tissues. 

Rounded  or  pyriform,   well- 
circumscribed;    hard;    firm; 
smooth  or  nodular;  white  or 
flesh-colored;  encapsulated  or 
non-encapsulated;  often  mul- 
tiple. 

Large     roundish     masses     or 
small  nodules. 

Neck,  groin,  axilla,  mediasti- 
num, etc. 

Myoma 

1.  Leiomyoma 

i.  Rhabdomyoma 

Smooth,  non-striated,  muscu- 
lar fibers,  such  as  occur  in  the 
uterus,  with  varying  quanti- 
ties  of   fibrous   tissue;   few 
blood-vessels.   The  fibers  are 
composed  of  spindle-shaped 
cells  containing  large,   rod- 
shaped  nuclei. 

Striated  muscular  fibers,  often 
undeveloped,  being  spindle- 
shaped,  and  associated  with 
sarcomatous  tissue. 

Uterus,  esophagus,  intestine, 
prostate,  stomach. 

Kidney,  ovary,  testicle;  ton- 
gue, heart. 

274 


APPENDIX  A 


Table  5  (concluded) 

Gould  and  Pyle's  Classification,  1914 

TUMORS,  TABLE  OF 


Name 

Histologic  Constituents 

Physical  Manifestations 

Seats  of  Peedilection 

Myxoma 

Delicate  network  of  stellate 
cells  enclosing  a  mucoid  in- 
tercellular substance.  _  Type. 
— Wharton's  jelly;   vitreous 
humor. 

Round  or  lobular;  soft,  gela- 
inous;   semitranslucent;   en- 
capsulated; elastic;   may  be 
fluctuating. 

Nasal  cavities;  mammae;  in- 
termuscular spaces;  sub- 
mucous and  subserous  tis- 
sues; back;  thighs;  lip;  cheek; 
labia;  clitoris;  prepuce;  scro- 
tum; axilla;  parotid;  ear; 
more  rarely  periosteum,  bone, 
heart,  and  nerve-sheaths. 

Neuroma 

Medullated  or  non-medullated 
nerve-fibers.       Very     rarely 
may  contain  ganglionic  cells; 
usually^  combined    with    fi- 
brous tissues. 

Spheric,  ovoid,  oblong,  or  bul- 
bous; sometimes  plexiform; 
firm;     painful    on  pressure; 
few    or    many    (even    hun- 
dreds). 

Cut  ends  of  nerves,  as  in 
stumps  of  amputation,  on 
skin. 

Osteoma 

Osseous  tissue  (cancellous  or 
compact  bone). 

Hard;  often  lobulated;  some- 
times spheric;   may  be  spi- 
nous or  spiculated;  peduncu- 
lated or  sessile;  usually  sin- 
gle;   may    be   multiple   and 
symmetric. 

Cranial  bones,  maxilla,  orbit; 
ends  of  phalanges;  juxta- 
epiphyseal  portions  of  long 
bones  (tibia,femur, humerus, 
etc.);  dura  mater;  muscle; 
aponeurosis;  lungs. 

Papilloma 

Hypertrophied  papillae  of  the 
skin;  varying  amount  of  con- 
nective   tissue    surrounding 
two  or  more  central  blood- 
vessels, and  covered  by  sev- 
eral layers  of  ephithelial  cells. 

A    form    of    sarcoma    (nest- 
celled)  .      Connective    tissue 
composed  of  flat,  elongated 
cells   of   great   size   and   in 
which  are  embedded  gritty 
concretions    that    are    com- 
posed of  calcium  carbonate. 

Embryonic  or  immature  con- 
nective tissue.    Blood-vessels 
without  walls,  or  thin-walled, 
ramifying  among  the  cells. 
Small  or  large  round  cells, 
embedded  in  a  small  amount 
of  granular  or  homogeneous 
intercellular  substance. 

Cells  varying  much  in  size, 
spindle-shaped,    with    long, 
fine     tapering     extremities, 
separated  by  very  little  in- 
tercellular substance.    Often 
have   a   fibrous   appearance 
(Recurrent  Fibroid). 

Masses   of    protoplasm    con- 
taining two  or  more  nuclei — 
up  to  20  or  50 —  with  a  vary- 
ing  amount  of   round   and 
spindle  cells. 

Alveolar  space  filled  with  sar- 
coma   cells;    the    trabeculse 
composed  of  spindle-cells. 

Sarcomata   of   various   kinds 
in  which  brownish  or  black 
pigment  becomes  deposited 
as  amorphous  granules  in  the 
cells  as  well  as  the  connective 
tissue  and  blood-vessel  walls 
of  the  tumor. 

Circumscribed;  hard  (on  the 
skin);     soft     (on     mucous 
membrane) ;  surface  smooth, 
brush-like,     or     cauliflower- 
like; single  or  multiple. 

Skin  of  hands  and  genitalia; 
larynx;  bladder;  rectum; 
nose. 

Psammoma 

Hard,     circumscribed;     light 
color. 

Membranes  of  brain,  choroid 
plexus;  pineal  gland;  spinal 
cord;  nerves. 

Sarcoma 

1.  Round-celled 

2    Spindle-celled 

8.  Giant-celled 
(Myeloid) 

4.  Alveolar 

5,  Melanotic 

Soft;  vascular;  whitish;  some- 
what translucent;   on   pres- 
sure after  some  hours  exudes 
a  milky  fluid;  round  or  ovoid, 
or  oblong. 

Firm;  reddish;  does  not  exude 
milky  fluid.    Shape  as  fore- 
going. 

Jelly-like  consistence  or  firm, 
like  muscle.    Shape  as  fore- 
going. 

Very  vascular;  soft. 

Rounded,  nodular,   dark  col- 
ored tumors  of  varying  size 
and      consistency,      usually 
hard. 

Periosteum;  bone;  lymphatic 
glands;  subcutaneous  tissue; 
testicle;  eye;  ovary;  lungs; 
kidneys;  intermuscular  septa. 

Subcutaneous  tissue;  fasciae 
and  intermuscular  septa; 
periosteum ;  interior  of  bones; 
eye;  antrum;  breast;  testicle. 

Lower  and  upper  jaw;  lower 
end  of  femur;  head  of  tibia. 

Skin;  eye;  bone;  lymphatic 
glands,  pia  mater  of  brain. 
Often  springs  from  warts. 

Where  pigment  occurs  nor- 
mally;_  the  eye  and  the  skin, 
the  pia;  secondarily,  espe- 
cially in  the  liver. 

Dermoid  Cyst 

Cyst  wall  contains  hair-folli- 
cles  and   sebaceous   glands. 
Contents.   —   Disintegrating 
epithelial   cells,    hair,   seba- 
ceo"s  matter,  teeth,  etc. 

Globular;      tense;       smooth; 
freely  movable. 

Outer  angle  of  orbit;  over  root 
of  nose;  ovary;  testicle. 

275 


APPENDIX  A 

Table  6 
Bertillon  International  Classification  of  Tumors 


Cancers  and  Other  Malignant  Tumors 

Note. — The  term  "Cancer,"  for  statistical  purposes,  is  a  general  one  that  includes 
all  forms  of  malignant  neoplasms. 


Forms  of  Cancer 


Adenocarcinoma 
Alveolar  cancer 

sarcoma 
Angiosarcoma 
Cancer 
Cancerous  new  growth 

tumor 

ulcer 
Carcinoma 

myxomatodes 
Cancroid 
Cephaloma 
Chondrosarcoma 
Colloid  carcinoma 

tumor 
Columnar-celled  carcinoma 
Cystosarcoma 
Encephaloid  cancer 

carcinoma 
tumor 
Endothelioma 
Epithelioma 
Fibrocarcinoma 
Fibrosarcoma 
Fungus  hsematodes 
Giant-celled  sarcoma 
Glandular  cancer 
Hsemendothelioma 
Heteromorphic  tumor 
Hypernephroma 
Lymphendothelioma 
Lymphosarcoma 
Malignant  degeneration 


Malignant  disease 

endothelioma 

fungous  tumor 

growth 

neoplasm 

new  growth 

perithelioma 

tumor 

ulcer 

ulceration 

Medullary  cancer 
fungus 

Melanoid  tumor 

Melanosarcoma 

Melanotic  cancer. 

Metastatic  cancer 

Myeloid  sarcoma 

Myxosarcoma 

Neoplastic  tumor  (malignant) 

Ossifying  sarcoma 

Osteosarcoma 

Papuliferous  carcinoma   • 

Plexiform  sarcoma 

Rose  cancer 

Round-celled  cancer 

Sarcoma 

Scirrhous  carcinoma 

Scirrhus 

Spheroidal-celled  carcinoma 

Spindle-celled  carcinoma 

Squamous-celled  carcinoma 

Superficial  cancer 

Transitional-celled  carcinoma 


The  location  of  the  cancer,  or  preferably,  as  recommended  by  the  Committee  of  the 
American  Medical  Association,  the  seat  of  origin  of  the  cancer,  if  known,  should  always  be 
stated  so  that  the  return  may  be  classified  properly  under  one  of  the  titles  39  to  45.  Non- 
malignant  tumors  or  "tumors"  of  uncertain  character  are  classified  under  the  organ  or 
part  of  the  body  affected  or  under  title  46. 


39.  Cancer  and  Other  Malignant  Tumors  of  the  Buccal  Cavity 


This  title  includes 

Cancer  and  other  malignant  tumors  of 
Buccal  cavity 
Cheek 
Gum 
Jaw 
Lip 

Maxilla 
Mouth 
Palate 


Cancer,  etc. — continued. 

Salivary  gland 

Soft  palate 

Tongue 

Tonsil 
Carcinoma  linguae 
Lingual  cancer 
Smokers'  cancer 


27G 


APPENDIX  A 

Table  6  (continued) 
Bertillon  International  Classification  of  Tumors 

40.  Cancer  and  Other  Malignant  Tumors  of  the  Stomach,  Liver 

This  title  includes 
Cancer  and  other  malignant  tumors  of 
Bile  duct 
Cardia 

Cardiac  orifice  of  stomach 
Gall  bladder 

duct 
Liver 

(Esophagus 
Pharynx 
This  title  does  not  include  Hsematemesis  (103). 


Cancer,  etc. — continued. 

Pylorus 

Stomach 
Carcinoma  ventriculi 
Gastric  tumor 
Gastrocarcinoma 
Hepatic  cancer 
Melanosis  of  liver 
Tumor  of  stomach 


41.  Cancer  and  Other  Malignant  Tumors  of  the  Peritonaeum,  Intestines, 

Rectum 


This  title  includes 
Cancer  and  other  malignant  tumors  of 
Abdominal  viscera 
Anus 
Appendix 
Caecum 
Caput  coli 
Colon 
Duodenum 
Ileum 

Intestinal  gland 
Intestine 
Mesentery 
Omentum 


Cancer,  etc. — continued. 
Peritonaeum 
Rectum 

Retroperitoneal  gland 
Sigmoid  flexure 
Cancerous  peritonitis 
Carcinoma  entericum 
Lymphosarcoma  of  peritonaeum 
Malignant  internal  stricture 
peritonitis 
stricture  of  intestine 
ulceration  of  intestine 
Retroperitoneal  cancer 


42.  Cancer  and  Other  Malignant  Tumors  of  the  Female  Genital  Organs 


This  title  includes 
Cancer  and  other  malignant  tumors  of 
Broad  ligament 
Cervix 

Falloppian  tube 
Female  genital  organ 
Ovary 

Uterine  ligament 
Uterus 
Vagina 
Vulva 


Cancer,  etc. — continued. 

Womb 
Cervical  cancer 
Chorioepithelioma 
Deciduoma  malignum 
Hydatid  mole 
Hydatidiform  mole 
Neoplasm  of  uterus 
Syncytioma 


43.  Cancer  and  Other  Malignant  Tumors  of  the  Breast 


This  title  includes 
Cancer  and  other  malignant  tumors  of 
Breast 

Mammary  gland 
Nipple 


Cancer,  etc. — continued. 
Cancer  en  cuirasse 
Neoplasm  of  breast 


277 


APPENDIX  A 

Table  6  (continued) 
Bertillon  International  Classification  of  Tumors 


44.  Cancer  and  Other  Malignant  Tumors  of  the  Skin 

This  title  includes 


Cancer  and  other  malignant  tumors  of 
Auricle  (of  ear) 
Chin 

Connective  tissue 
Ear 
Face 
Head 
Nose 
Scalp 
Skin 


Cancer,  etc. — continued. 

Umbilicus 
Cancroid  (unqualified) 
Cervicofacial  cancer 
Columnar  epithelioma 
Epithelial  tumor  (location  not  indicated) 
Epithelioma  (location  not  indicated) 
Noli  me  tangere 
Rodent  dermatitis 
ulcer 


This  title  does  not  include  Esthiomene  (34). — Lupus  (34). 


45.  Cancer  and  Other  Malignant  Tumors  of  Other  Organs  or  of  Organs 

not  Specified 

Note. — This  is  a  residual  title  that  includes  all  deaths  from  cancer  that  can  not  be 
assigned  to  the  preceding  titles,  39-44,  and  especially  those  in  which  the  location  or  origin 
of  the  disease  is  not  stated.  Inquiry  should  be  made  in  such  cases  and  fuller  information 
obtained  if  possible. 

This  title  includes 

Cancer  and  other  malignant  tumors,  with 
location  not  stated,  or  of 

Abdomen 

Accessory  sinus 

Adrenal 

Anterior  mediastinum 

Antrum 

Arm 

Artery 

Axilla 

Back 

Bladder 

Body 

Bone 

Brain 

Bronchi 

Cervical  gland 

Chest 

Chorioid 

Conjunctiva 

Cord 

Cornea 

Extremity 

Eye 

Fauces 

Ganglia 

Genital  organ  (male) 

Gland 

Glandular  system 

Groin 

Hand 

Heart 

Hip 

Iliac  region 


Cancer,  etc. — continued. 
Inguinal  gland 
region 
Iris 
Joint 
Kidney 

Lacrimal  apparatus 
Larynx 
Leg 

Lower  extremity 
Lung 

Lymph  gland 
node 
Lymphatic  gland 
vessel 
Mediastinal  gland 
Mediastinum 
Membrane  of  brain 

spinal  cord 
Meninges 
Muscle 
Nates 
Neck 
Nerve 
Orbit 
Pancreas 
Parotid  gland 
Pectoral  region 
Pelvic  viscera 
Pelvis 
Penis 

Pericardium 
Perinaeum 


278 


APPENDIX  A 

Table  6  (continued) 
Bertillon  International  Classification  of  Tumors 


45.  Cancer  and  Other  Malignant  Tumors  of  Other  Organs  or  of  Organs 
not  Specified  (concluded) 


Cancer,  etc. — continued. 
Pleura 

Posterior  nares 
Prepuce 
Prostate 
Sacrum 
Scapula 
Scrotum 
Shoulder 
Spinal  cord 
Spine 
Spleen 
Sternum 
Suprarenal 
Temporal  region 
Testicle 
Thorax 
Throat 

Thymus  gland 
Thyreoid 
Trachea 

Upper  extremity 
Ureter 
Urethra 
Vertebra 
Viscera 
Zygoma 

This  title  does  not  include  Cancer  of  oesophagus  (40). — Cancer  of  the  anus  (41). — Cancer  of  the  ovary,  of 
the  vagina,  of  the  vulva  (42). 


Cancerous  cachexia 

goitre 

humor 

neuritis 

toxaemia 
Carcinomatous  septichsemia 
Chimney-sweeps'  cancer 
Disseminated  cancer 
General  carcinomatosis 

sarcomatosis 
Intraabdominal  cancer 
Lobstein's  cancer 
Malignant  disease  (undefined) 

fistula 

prostatitis 
Miliary  carcinosis 
Multiple  cancer 

melanosarcomata 
Pelvic  cancer 
Pulmonary  cancer 
Renal  cancer 
Retropharyngeal  cancer 
Rhabdomyosarcoma  of  kidney 
Sarcocele 

Sarcomatosis  (unqualified) 
Sarcomatous  phlebitis 
Thyreosarcoma 


46.  Other  Tumors  (Tumors  of  the  Female  Genital  Organs  Excepted) 

Note. — The  term  "Tumor/'  for  statistical  purposes,  is  a  general  one  that  includes 


all  forms  of  nonmahgnant  neoplasms. 


Forms  of  Tumor 


Adenofibroma 
Adenoma 
Adenomyxoma 
Angioma 
Arterial  angioma 
Benign  tumor 
Blood  tumor 
Cartilaginous  tumor 
Cavernous  lymphangioma 

nsevus 
Chondroma 
Cyst 

Cystadenoma 
Cystic  hygroma 

lymphangioma 

tumor 
Cystoma 
Dermoid  cyst 
Enchondroma 


Erectile  tumor 
Fatty  tumor 
Fibroid 

tumor 
Fibrolipoma 
Fibroma 

molluscum 
Fibroplastic  tumor 
Fibrous  tumor 
Fungous  tumor 
Ganglionic  neuroma 
Glandular  cyst 

tumor 
Glioma 
Hsemangioma 
Hsematoma  (nontraumatic) 
Leiomyoma 
Lipoma 
Lymphangioma 


279 


APPENDIX  A 

Table  6  (concluded) 
Bertillon  International  Classification  of  Tumors 


46.  Other  Tumors  (Tumors  of  the  Female  Genital  Organs  Excepted) 

(concluded) 

Forms  of  Tumor 


New   growth    (nonmalignant   or   unquali- 
fied) 
Papilloma 
Polypus 
Retention  cyst 
Rhabdomyoma 
Sebaceous  cyst 

tumor 
Sequestration  dermoid  cyst 
Serous  cyst 
Striped  muscle  tumor 
Suppurative  cystic  tumor 
Teratoma 

Tumor  (nonmalignant  or  unqualified) 
Vascular  tumor 


Lymphatic  naevus 

Lymphatocele 

Lymphoma 

Mucous  cyst 

Myoma 

Myxochondroma 

Myxofibroma 

Myxoma 

Nsevolipoma 

Neoplasm  (nonmaligjiant  or  unqualified) 

Neoplastic  growth   (nonmalignant  or  un- 
qualified) 
tumor    (nonmalignant   or   un- 
qualified) 

Neurofibroma 

Neurofibromatosis 

The  location  of  the  tumor  should  always  be  stated.  The  word  "tumor"  is  frequently 
used  indefinitely  and  may  mean  a  malignant  tumor  or  cancer  (titles  39  to  45);  inquiry 
should  always  be  made  on  this  point  and  a  definite  statement  of  malignancy  or  non- 
malignancy  obtained  if  possible.  Title  46  is  misleading  in  its  wording  because  not  only 
are  tumors  of  the  female  genital  organs  (uterus,  ovary)  excepted,  but  also  all  other  tumors 
that  can  be  referred  to  a  definite  organ  or  part  of  the  body.  The  title  is  a  residual  one 
and  contains  only  those  tumors  for  which  the  location  is  ill  defined  or  not  stated. 

This  title  includes 

Billroth's  disease 
Myomectomy 
Pelvic  tumor 
Rupture  of  cyst 

Tumor  (see  forms  of  tumor  above),  with 
location  not  stated,  or  of — 

Abdomen 

Axilla 

Blood  vessel 

Chest 


Tumor,  etc. — continued. 
Connective  tissue 
Gland 
Hip 

Mediastinal  gland 
Mediastinum 
Muscle 
Neck 
Thorax 


This  title  does  not  include  Cancer  and  its  synonyms  (39-45). — Tumor  of  the  stomach  (40). — Stercoral 
tumor  (109) — Tumor  of  the  uterus  (129). — Hydatid  tumor  (112). — Cyst  of  the  ovary  (131). — Aneurysmal 
tumor  (81). — Varicose  tumor  (83). — ^Polypus  of  the  ear  (76). — Polypus  of  the  nasal  fossae,  or  nasopharynx 
(86). — Uterine  polypus  (129) — [and  many  other  "tumors."     See  Cancer  and  Tumor  in  Index.] 

Frequent  complication:  Purpura, 


280 


APPENDIX  A 

Table  7 
Bertillon  International  Classification  of  Diseases  Allied  to  Tumors 


This  title  includes 
Cysticercus  cellulosse 

of  liver 
Echinococcus 

cyst  of  liver 
of  liver 
Hydatid  (unquali6ed) 
cyst 


This  title  includes 

Biliary  calculus 

colic 

lithiasis 
Calculus  of  gall  bladder 

liver 
Cholsemic  gall  stones 
Cholelithiasis 
Colic  from  gall  stones 


112.  Hydatid  Tumor  of  the  Liver 


Hydatid  cyst  of  liver 
disease 
of  liver 
tumor 

of  liver 


114.  Biliary  Calculi 

Gall  stones 


in  mtestine 
Hepatic  calculus 

colic 
Impacted  calculus  of  liver 

gall  stones 
Impaction  of  gall  bladder 


102.  Ulcer  of  the  Stomach 


This  title  includes 
Erosion  of  stomach 
Gastric  erosion 

ulcer 

ulceration 
Gastroduodenal  ulcer 
Gastrooesophageal  ulcer 
Peptic  ulcer 
Perforating  gastric  ulcer 

Frequent  complications:  Hsematemesis. — Perforation  of  the  stomach 


Perforating  ulcer  of  stomach 
Round  ulcer 

of  stomach 
Ulcer  of  peptic  gland 
pylorus 
stomach 
Ulcus  rotundum 
ventriculi 


-Peritonitis. — Subphrenic  abscess 


This  title  includes 


123.  Calculi  of  the  Urinary  Passages 


Calculous  disease 
pyelitis 
pyelonephritis 
pyonephrosis 
Calculus 

of  bladder 
kidney 

pelvis  of  kidney 
ureter 
urethra 
urinary  duct 

passage 
tract 
Cystic  calculus 
Gravel  (imnary) 
Impacted  calculus  of  kidney 
ureter 
urethra 
renal  calculus 

This  title  does  not  include  Prostatic  calculi  (126). 


Lithiasis 
Lithoclasty 
Lithotomy 
Lithotrity 
Nephritic  calculus 

colic 
Nephrolithiasis 
Nephrolithotomy 
Pyonephrosis  from  calculus 
Renal  calculus 

colic 
Stone 

in  bladder 
kidney 
Ureteral  colic 
Ureterolithotomy 
Urinary  calculus 
lithiasis 
Vesical  calculus 


281 


APPENDIX  A 

Table  7  (concluded) 
Bertillon  International  Classification  of  Diseases  Allied  to  Tumors 


129.  Uterine  Tumor  (Noncancerous) 


This  title  includes 


Bleeding  fibroid  (female) 
Cystic  degeneration  of  utenls 
Deciduoma 
Fibrocyst  of  uterus 
Fibroid  body  of  uterus 

of  cervix  of  uterus 

uterus 
tumor  of  female  genital  organ 
uterus 
Fibroma  (female) 

of  uterus 
Fibromyoma 

of  uterus 


Fimgoiis  growth  of  uterus 

Huguier's  disease 

Hysteromyoma 

Hysteromyomectomy 

Multiple  fibroid 

Myoma  of  uterus 

New  growth  of  uterus  (nonmalignant) 

Polypus  of  uterus 

Recurrent  cyst  of  uterus 

Submucous  fibroid  (female) 

Tumor  of  uterus 


131.  Cysts  and  Other  Tumors  of  the  Ovary 


This  title  includes 

Castration  (female) 

Cyst  of  ovary 

Cystic  ovary 

Cystoma  of  ovary 

Dermoid  cyst  of  ovary 

Dropsy  of  ovary 

Encysted  dropsy 

Fibroid  of  ovary 

Hsematoma  of  ovary 

Multilocular  cyst 

New  growth  of  ovary  (nonmalignant) 


Oophorectomy 
Ovarian  cyst 

dropsy 

tumor 
Ovariotomy 
Papilloma  of  ovary 
Paracentesis  of  cyst  of  ovary 

parovarian  cyst 
Parasitic  disease  of  ovary 
Parovarian  cyst 
Tumor  of  ovary 


Tables  6  and  7  are  derived  from  the  Manual  of  the  International  List  of  Causes  of  Death,  2d  ed. 
Government  Printing  Office,  Washington,  1913.  See  also  in  this  connection  Index  of  Joint  Causes  of  Death, 
Government  Printing  Office,  Washington,  1914.  Both  of  these  publications  are  issued  by  the  Bureau  of  the 
Census,  Division  of  Vital  Statistics. 

282 


APPENDIX  A 

Table  8 
Imperial  Cancer  Research  Fund  Classification,  1903 

Note  explaining  the  three  groups  "accessible,"  "inaccessible,"  and 
"intermediate."  The  terms  refer  to  the  site  of  the  primary  growth. 
The  grouping  is  adopted  for  the  purposes  of  this  report  and  may  require 
to  be  modified  when  we  have  to  interpret  the  data  for  a  greater  number 
of  years.* 

Accessible.  Skin,  Sub-cutaneous  Tissue,  Lips,  Tongue,  Floor  of 
Mouth,  Buccal  Mucous  Membrane,  Antrum, 
Maxilla,  Mandible,  Palate,  Tonsil,  Eye,  Eyelid, 
Orbit,  Cervical  glands.  Breast,  Sternum  and  Ribs, 
Scapula,  Clavicle,  Humerus,  Bones  of  Arm,  Annu- 
laris, Bones  of  Lower  Limbs,  Muscles  of  Trunk, 
Muscles  of  Upper  Limbs,  Muscles  of  Lower  Limbs, 
Penis,  Scrotum,  Testis,  Clitoris,  Vulva,  Vagina, 
Anus. 

Inaccessible.  Brain  and  Spinal  Cord,  Pharynx,  (Esophagus,  Lung, 
Pleurae  and  Mediastinum,  Tracheal  glands.  Medi- 
astinal glands.  Heart,  Pericardium,  Stomach,  Small 
Intestine,  Caecum,  Appendix,  Colon,  Hepatic  Flex- 
ure, Splenic  Flexure,  Sigmoid,  Liver  and  Gall- 
Bladder,  Pancreas,  Adrenal,  Kidney,  Ureter,  Blad- 
der, Prostate,  Retro-peritoneal  glands.  Perito- 
neum, Ovary,  Spinal  Column,  Sacrum,  Pelvic  Bones. 

Intermediate.  Skull,  Larynx  and  Epiglottis,  Trachea,  Parotid,  Urethra, 
Rectum,  Uterus,  Thyroid,  Glands  not  specified. 
Nerves,  Site  not  specified. 

King  and  Newsholme  in  their  report  on  "The  Alleged  Increase  of 
Cancer,"  read  before  the  Royal  Society  in  1893,  divided  cancers  into 
only  two  groups,  accessible  and  inaccessible.  They  explain  their  classi- 
fication as  follows:  "Under  'Accessible  cancer'  we  have  included 
only  the  four  headings.  Tongue,  Mamma,  Uterus  and  Vagina,  all  of 
which  are  capable  of  careful  and  exact  diagnosis.  Under  'Inac- 
cessible cancer'  come  cancers  primarily  affecting  any  other  part  of  the 
body.  .  .  .  The  classification  cannot  be  regarded  as  perfect. 
Thus  it  may  be  pointed  out  that  the  first  group  embraces  a  large 
excess  of  women,  among  whom  it  is  shown  by  the  Registrar- 
General's  returns  in  Great  Britain  that  the  apparent  increase  in  cancer 
has  been  in  less  ratio  than  among  men.  In  the  next  place,  it  may  be 
argued  that  we  have  placed  under  the  'inaccessible'  division  cancer  of 
certain  parts  that  might  be  more  appropriately  described  as  accessible." 

'Scientific  Reports  on  the  Investigations  of  the  Imperial  Cancer  Research  Fund,  by  Dr.  E.  F.  Bashford. 
Report  No.  2,  Part  I.— The  Statistical  Investigation  of  Cancer,  London,  1905. 

283 


APPENDIX 

B 

Cancer  Records,  Inquiry  Blanks  and  Forms 


Table  Page 

1  United  States  Standard  Death  Certificate 285 

2  Cancer  Inquiry  Blank  of  the  Imperial  Cancer  Research  Fund 287 

2a  Statistics  showing  the  frequency  with  which  microscopical  examination  in  cases 

of  Carcinoma  and  Sarcoma  is  made  in  Operation  and  Post-Mortem 
material  and  the  proportion  of  cases  in  each  group  in  which  Cancer  was 

diagnosed 288 

3  Cancer  Blank  of  the  New  York  State  Department  of  Health 290 

4  Question  Form  for  International  Cancer  Statistics 292 

5  Question  Form  of  the  George  Crocker  Special  Research  Fund 294 

6  Uterine  Cancer  Blank  of  the  American  Society  for  the  Control  of  Cancer 296 

7  Buccal  Cavity  Cancer  Blank  of  the  American  Society  for  the  Control  of  Cancer. ,  298 

8  Mammary  Cancer  Blank  of  the  American  Society  for  the  Control  of  Cancer 300 

9  Gastric  Cancer  Blank  of  the  American  Society  for  the  Control  of  Cancer 302 

10    Supplementary  Letter  of  Inquiry  on  Statistics  of  Cancer  of  the  Division  of  Vital 

Statistics  of  the  United  States  Census 304 


284 


APPENDIX  B 

Table  1 
United  States  Standard  Death  Certificate 


WRITE  PLAINLY,  WITH  UNFADING  INK— THIS  IS  A  PERMANENT  RECORD 

N.  B. — Every  item  of  information  should  be  carefully  supplied.  AGE  should  be  stated  EXACTLY. 
PHYSICIANS  should  state  CAUSE  OF  DEATH  in  plain  terms,  so  that  it  may  be  properly  classified.  Exact 
statement  of  OCCUPATION  is  very  important.     See  instructions  on  back  of  certificate. 


I  Place  of  Death 

County 

Township 

or 
Village 

or 
City 

2  Full  Name 


Department  of  Commerce 

BUREAU  OF  THE  CENSUS 


STANDARD  CERTIFICATE  OF  DEATH 
State  of 


Registered  No. 


•  •  •  •  Qlf  death  oconned  In 

ft  hospital  or  InBtitutlon, 

.  (No , St.; Ward)  p"  '"  "ame  iMt»d 

of  street  and  nnmher.  j 


PERSONAL  AND  STATISTICAL  PARTICULARS 


4  COLOR  OB  RACE 


5  Single, 
Married, 
Widowed, 
or  Divorced 
(Write  the  word) 


6  DATE  OF  BIRTH 


.,1. 


(Jav)  (Year) 


. .  .yrs. 


If  LESS  than 

1  day hrs. 

or min.? 


i  OCCUPATION 

(a)  Trade,  profession,  or 
particular  kind  of  work 

(b)  General  nature  of  Industry, 
business,  or  establishment  in 
which  employed  (or  employer) . 


I  BIRTHPLACE 

(State  or  country) 


10  NAME  OP 
FATHER 


II  BIRTHPLACE 
OF  FATHER 

(State  or  country) 


12  MAIDEN  NAME 
OF  MOTHER 


13  BIRTHPLACE 
OF  MOTHER 

(State  or  country) 


14  THEABOVEISTRUETOTHE  BEST  OF  MY  KNOWLEDGE 

(Informant) 

(Address) 


15 


FUed. 


.,191. 


Registrar 


MEDICAL  CERTIFICATE  OF  DEATH 


16  DATE  OF  DEATH 


(Month) 


(Day) 


.,191.. 

(Year) 


17 1  HEREBY  CERTIFY,  That  I  attended  deceased 

from ,  191...  to 191.., 

that  I  last  saw  h . . . .  alive  on ,  191 . . , 

and  that  death  occurred,  on  the  date  stated  above, 
at m.  The  CAUSE  OF  DEATH*  was  as  fol- 
lows:  


.  (Duration) yrs mos. 


Contributory 

(Seccmdary) 

(Duration) yrs mos ds. 

(Signed) M.   D. 

191 . .     (Address) 

*State  the  Disease  Causing  Death,  or,  in  deaths 
from  Violent  Causes,  state  (1)  Means  of  Injury; 
and  (2)  whether  Accidental,  Suicidal,  or  Homi- 
cidal. 

18  length  of  residence  (For  Hospitals,  Institu- 
tions, Transients,  or  Recent  Residents) 
At  place  In  the 

of  death,  .yrs.  .  .mos.  .  .ds.  State,  .yrs.  .  .mos.  .  .ds. 
Where  was  disease  contracted, 

if  not  at  place  of  death? 

Former  or 

usual  residence 


19  place  of  burial  or 
removal 


20  UNDERTAKER 


DATE  OF  BURL\L 


285 


APPENDIX  B 

Table  1  (concluded) 
United  States  Standard  Death  Certificate 

(reverse) 


Revised  United  States  Standard  Certificate  of  Death 

[Approved  by  U.  S.  Census  and  American  Public  Health  Association] 


Statement  of  occupation. —  Precise 
statement  of  occupation  is  very  important, 
so  that  the  relative  healthfulness  of  various 
pursuits  can  be  known.  The  question 
applies  to  each  and  every  person,  irre- 
spective of  age.  For  many  occupations  a 
single  word  or  term  on  the  first  line  will  be 
sufficient,  e.  g..  Farmer  or  Planter,  Physi- 
cian, Compositor,  Architect,  Locomotive 
engineer.  Civil  engineer.  Stationary  fireman, 
etc.  But  in  many  eases,  especially  in 
industrial  employments,  it  is  necessary  to 
know  (a)  the  kind  of  work  and  also  (6)  the 
nature  of  the  business  or  industry,  and 
therefore  an  additional  line  is  provided  for 
the  latter  statement;  it  should  be  used  only 
when  needed.  As  examples:  (a)  Spinner, 
(6)  Cotton  mill;  (a)  Salesman,  (b)  Grocery; 
(a)  Foreman,  (6)  Automobile  factory.  The 
material  worked  on  may  form  part  of  the 
second  statement.  Never  retiu-n  "Lab- 
orer," "Foreman,"  "Manager,"  "Dealer," 
etc.,  without  more  precise  specification,  as 
Day  laborer.  Farm  laborer.  Laborer — Coal 
mine,  etc.  Women  at  home,  who  are 
engaged  in  the  duties  of  the  household 
only  (not  paid  Housekeepers  who  receive  a 
definite  salary),  may  be  entered  as  House- 
wife, Houseicork,  or  At  home,  and  children, 
not  gainfully  employed,  as  At  school  or  At 
home.  Care  should  be  taken  to  report 
specifically  the  occupations  of  persons 
engaged  in  domestic  service  for  wages,  as 
Servant,  Cook,  Housemaid,  etc.  If  the 
occupation  has  been  changed  or  given  up 
on  account  of  the  disease  causing  death, 
state  occupation  at  beginning  of  illness. 
If  retired  from  business,  that  fact  may  be 
indicated  thus:  Farmer  {retired,  6  yrs.). 
For  persons  who  have  no  occupation  what- 
ever, write  None. 

Statement  of  cause  of  death. — 
Name,  first,  the  disease  causing  death 
(the  primary  afl^ection  with  respect  to  time 
and  causation),  using  always  the  same  ac- 
cepted term  for  the  same  disease.  Ex- 
amples: Cerebrospinal  fever  (the  only  defi- 
nite synonym  is  "Epidemic  cerebrospinal 
meningitis");  Diphtheria  (avoid  use  of 
"(■roup");  Typhoid  fever  (never  report 
"Typhoid  pneumonia");  Lobar  pneumonia; 


Bronchopneumonia  ("Pneumonia,"  unqual- 
ified, is  indefinite);  Tuberculosis  of  lungs, 
meninges,  peritoneum,  etc..  Carcinoma,  Sar- 
coma, etc.,  of (name  origin;  "Can- 
cer" is  less  definite;  avoid  use  of  "Tumor" 
for  malignant  neoplasms) ;  Measles;  Whoop- 
ing cough;  Chronic  valvular  heart  disease; 
Chronic  interstitial  nephritis,  etc.  The 
contributory  (secondary  or  intercurrent) 
affection  need  not  be  stated  unless  im- 
portant. Example:  Measles  (disease  caus- 
ing death),  89  ds.;  Bronchopneumonia 
(secondary),  10  ds.  Never  report  mere 
symptoms  or  terminal  conditions,  such  as 
"Asthenia,"  "Anaemia"  (merely  sympto- 
matic), "Atrophy,"  "Collapse,"  "Coma," 
"Convulsions,"  "Debility"  ("Congenital," 
"Senile,"  etc.),  "Dropsy,"  "Exhaustion," 
"Heart  failure,"  "Haemorrhage,"  "Inani- 
tion," "Marasmus,"  "Old  age,"  "Shock," 
"Uraemia,"  "Weakness,"  etc.,  when  a 
definite  disease  can  be  ascertained  as  the 
cause.  Always  qualify  all  diseases  result- 
ing from  childbirth  or  miscarriage,  as 
"Puerperal  septichaemia,"  "Puerperal 
peritonitis,"  etc.  State  cause  for  which 
surgical  operation  was  undertaken.  For 
violent  deaths  state  means  of  injury  and 
qualify  as  accidental,  suicidal,  or  homi- 
cidal, or  as  probably  such,  if  impossible  to 
determine  definitely.  Examples:  Acci- 
dental drowning;  Struck  by  railway  train — 
accident;  Revolver  wound  of  head — homicide; 
Poisoned  by  carbolic  acid — probably  suicide. 
The  nature  of  the  injury,  as  fracture  of 
skull,  and  consequences  (e.  g.,  sepsis, 
tetanus)  may  be  stated  under  the  head  of 
"Contributory."  (Recommendations  on 
statement  of  cause  of  death  approved  by 
Committee  on  Nomenclature  of  the  Ameri- 
can Medical  Association.) 

Note. — Individual  oflSces  may  add  to  above  list 
of  undesirable  terms  and  refuse  to  accept  certifi- 
cates containing  them.  Thus  the  form  m  use  in 
New  York  City  states:  "CertiBcates  will  be  returned 
for  additional  information  which  give  any  of  the 
following  diseases,  without  explanation,  as  the  sole 
cause  of  death:  Abortion,  cellulitis,  childbirth,  con- 
vulsions, haemorrhage,  gangrene,  gastritis,  erysipelas, 
meningitis,  miscarriage,  necrosis,  peritonitis,  phle- 
bitis, pyaemia,  septichaemia,  tetanus."  But  general 
adoption  of  the  minimum  list  suggested  will  work 
vast  improvement,  and  its  scope  can  be  extended  at  a 
later  date. 

11—3184 


28(i 


APPENDIX  B 

Table  2 
Cancer  Inquiry  Blank  of  the  Imperial  Cancer  Research  Fund 


Year Hospital  Refce Age ....  Sex ....  Occup . 

Microscopical  Examination 


Q  at  operation 

P 

f^  r 

5  at  P.  M.  ] 

5       .    .  (. 

^  Clinical 

m  Diagnosis Primary  Site. 


Secondaries . 


^  Cachexia Ulceration Obstruction . 

^  Z)afe  of  Dates  of 

•?1  Primary  Operation Recurrences 

\  Ti 

Family  History. 


h-3 


^     -"•""'^  .^...^.y 

I— I  (^  i^' 

g  r  Duration Puberty ....  Menopause. . 

p_i  Personal  History  < 

^  I 


Date  of  Death Age  at  Death. 

Duration  of 
Residence Residence 


Cross  References. 
Remarks 


•UNIFORMITY  IN  HOSPITAL  STATISTICS 

"A  preliminary  inquiry  was  made  to  ascertain  whether  or  not  sufficiently  extensive  statistics  of  cancer,  of  the 
nature  described  above,  could  be  compiled.  The  results  showed  that  several  of  the  metropolitan  hospitals  were 
in  a  position  to  supply  positive  information  on  all  the  headings  under  which  facts  were  sought.  It  was  then 
necessary  to  devise  means  for  the  systematic  utilisation  of  these  facts  and  to  obtain  the  collaboration  of  the 
hospital  authorities  in  securing  a  uniform  method  of  investigating,  classifying  and  recording  cases  of  malignant 
new  growths  and  of  growths  which  had  been  erroneously  regarded  as  malignant.  This  was  secured  by  the 
majority  of  the  hospital  authorities,  who  directed  certain  members  of  their  staffs  to  record  all  cases  on  cards, 
containing  headings  arranged  as  shown  opposite,  and  to  forward  them  to  the  office  of  the  Imperial  Cancer 
Research  Fund.  By  this  means  a  card  index  of  nearly  all  the  cases  occurring  in  the  metropolitan  hospitals  is 
provided.  With  the  help  of  such  cards,  the  information  can  be  readily  classified  under  any  heading.  The 
headings  under  which  information  is  asked  must  of  necessity  be  determined  by  the  progress  of  the  entire 
investigation.  The  card  reproduced  opposite  has  been  in  use  since  the  inquiry  was  started.  It  was  devised  to 
elicit  as  much  information  as  possible  and  may  be  modified  to  meet  any  future  requirements  of  the  research. 
The  uniformity  thus  attained  in  some  of  the  metropolitan  hospitals  has  been  the  ideal  to  which  the  investigations 
in  the  Colonies  and  elsewhere  has  been  made  to  approximate,  and  cannot  fail  to  react  upon  statistical  inquiries 
on  cancer  generally."     '(Statistical  Investigations  of  Cancer,  Part  1,  page  10,  London,  1905.) 

287 
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289 


APPENDIX  B 

Table  3 
Cancer  Blank  of  the  New  York  State  Department  of  Health 


NEW  YORK  STATE  DEPARTMENT  OF  HEALTH 

BUREAU  OF  VITAL  STATISTICS 


Record  of  Death  by  Cancer 

With  Additional  Infobmation  for  New  York  State  Cancer 
Research  Statistics 


Full  name 

Place  of  death 

Home  or  usual  residence 

Single 

Married. . . 

Sex Color  or  race. „„  ,        , 

Widowed. . 

Divorced . . 

Date  of  birth Date  of  death 

Age 

Occupation.     Nature  of  work 

Nature  of  industry  or  estabUshment  in  which  employed 

Birthplace 

How  long  resident  of  present  locality 

Name  of  father Birthplace  of  father. . 

Maiden  name  of  mother Birthplace  of  mother. 

Name  and  address  of  informant 


Deceased  died  of  cancer  of 

Any  other  terminal  or  accessory  disease . . 

Duration  of  cancer 

Duration  of  terminal  disease 

Name  of  physician  filing  death  certificate . 
Address 


N.  B.    Please  fill  out  blank  lines  above  remaining  unanswered  from  the  death  cer- 
tificate and  give  additional  information  requested  on  back  of  form.  (over) 

290 


APPENDIX  B 

Table  3  (concluded) 
Cancer  Blank  of  the  New  York  State  Department  of  Health 

(reverse) 


Additional  Data  Requested 

1.  Was  there  history  of  possible  hereditary  origin  of  the  cancer 

2.  Was  there  history  in  the  deceased  of  (yes  or  no)  Tuberculosis ....     Syphilis .... 

Alcoholism ....     Other  chronic  illness  (please  name) 

3.  Had  the  patient  suffered  any  traimia,  ulcer,  or  other  similar  irritative  condition  which 

led  up  to  and  might  have  initiated  the  cancer  (e.  g.,  gastric  ulcer,  cervical  tear, 
chronic  mastitis,  inveterate  use  of  pipe  or  cigarette,  pessary,  single  or  multiple 
childbirth,  etc.) 

4.  If  not  clearly  recorded  in  the  death  certificate  please  state  to  the  best  of  your  knowl- 

edge and  belief: 

(a)  Where  did  the  primary  growth  arise.'' 

(6)  When  did  this  growth  probably  begin.'' 

(c)   In  what  locality  was  patient  when  the  growth  began.' 

5.  What  was  the  first  distinct  symptom  or  sign.'' 

6.  Were  there  metastases.'' 

7.  Was  the  diagnosis  confirmed  either  before  or  after  death  by  microscopic  examination 

of  the  growth.? 

8.  If  so,  what  was  the  pathological  diagnosis.'' 

9.  What  measures,  medical  or  surgical,  or  both,  were  employed  (e.  g..  X-ray,  Radium, 

Toxins,  Cautery,  or  Operative  removal) .'' 

10.  What  was  the  result  of  these  measures.'' 


Note. — In  your  personal  experience  of  the  past  15  years  can  you  refer  to  any  person 
or  persons  now  living,  having  spontaneously  recovered  from  an  undoubted  cancer,  of  which 
the  diagnosis  was  confirmed  by  microscopic  examination: 

Name 

Address ^ 

Name  of  physician  answering  above  questions 

Address 

291 


APPENDIX  B 

Table  4 
Question  Form  for  International  Cancer  Statistics 

Question-form^ 

for 

International  cancer  statistics. 

Name  of  the  country,  national  committee 

Local  board,  office 

Census  form  for  a  death  case  from  a  cancer  patient.^ 

Residence  of  the  deceased 

Administrative  district  (country  or  province,  etc.) 

State 

A.  General  Report. 

1.  Christian  and  surname  of  the  deceased  (both  the  first  initials  of  the 

Christian  and  surname) : 

2.  Sex:  male?  female?' 

3.  Day  of  death: 

4.  Age :  born  on (if  the  day 

of  birth  not  known,  the  age  in  completed  years) 

5.  Social  state:  single?  married?  widowed?  divorced? 

6.  Nationality: 

7.  In  what  profession  or  trade  was  the  deceased  last  and  formerly  em- 

ployed (social  position:  independent?  employer?  workingman? 

servant?  etc.) : 

In  the  case  of  female  persons,  besides  her  own  vocation,  that  of 
the  husband  or  father : 

8.  a  Last  residence: 

If  the  patient  died  in  a  hospital,  the  last  residence  before  entering 
the  same  (street,  house-number,  story,  front -house,  back-premises, 
etc.) 

h  Residence  at  the  time  of  getting  sick: 

1  All  questions  which  can  not  be  positively  answered  with  "y^s"  or  "no"  should 
receive  the  answer  "uncertain." 

2  As  death  from  cancer  is  to  be  considered,  every  death  case  of  a  cancer 
patient,  even  though  death  resulted  from  another  cause  (suicide,  apoplexy,  etc.). 

3  In  women,  the  maiden  name.     Unappropriate  questions  here  and  elsewhere  are 
to  be  crossed  out. 

292 


APPENDIX  B 

Table  4  (concluded) 
Question  Form  for  International  Cancer  Statistics 

B.  Special  Report. 

9.  Was  the  deceased  sick  before?  and  when? 

with  tuberculosis  ? 

"      syphilis? 

"      malaria? 

"      alcoholism? 

"      trauma? 

"      (Ulcer  of  the  stomach?) 

Was  he  vegetarian? ,  . 

In  women 

a  with  inflammations  in  the  sphere  of  the  genital  organs? 

When? 

b  In    the    case    of    uterine    or    vaginal   cancer:    was    a   pessary 

worn? 

c  How  many  births  and  abortions  occurred? 

In  the  case  of  Ungual  cancer  or  cancer  of  the  mouth :    Was  the  deceased 
a  smoker? (pipe?  cigars?  cigarettes?) 

10.  a  Primary  seat  and  nature  of  the  cancer  (was  the  diagnosis  made 

with  the  aid  of  a  microscopical  examination?     Yes.     No. 
By  whom?     What  was  the  result?) 

b  Was  the  organ  primarily  affected  by  previous  sickness  or  lesions? 
Did  chronic  inflammatory  processes  exist  and  which?  In  the 
case  of  relapses  resp.  metastases,  where  was  the  seat  of  the  primary 
swelling? 

c  Did  the  tumor  grow  on  a  basis  of  a  benign  tumor? 

11.  a  When  did  the  ailment  apparently  commence?     The  year 

(If  possible,  accurate  date) 

b  Which  was  the  first  distinct  symptom? 

12.  Was  the  malady  treated  operatively  or  locally  with  Roentgen,  Ra- 

dium, etc. ? 

What  was  the  nature  of  measures  employed? 

When  were  these  measures  employed? 

What  was  the  result  of  these  measures  on  the  local  and  on  the  gen- 
eral condition  of  the  patient? 

Did  relapses  or  metastases  occur? 

where? when? 

13.  Immediate  cause  of  death  :^ 

14.  Was  an  autopsy  made?     Yes.     No.     By  whom? 

What  was  the  result  of  this  autopsy  with  reference  to  cancer? 

Were  microscopical  post-mortem  examinations  undertaken? 

By  whom  ? : 

What  was  the  result? 

15.  Remarks: 

Place : Date : 

1  Suicide,  pneumonia,  etc.    Signature  (Stamp)   (of  the  certifying  physician) 

293 


APPENDIX  B 

Table  5 
Question  Form  of  the  George  Crocker  Special  Research  Fund 


DEPARTMENT  OF  PATHOLOGY 


Cancer  Schedule,  No.. 


1.  Attending  Surgeon — Dr. 

2.  Place  and  date  of  record... 


(State  address  of  Attending  Surgeon  or  name  of  hospital) 

3.  Name  of  patient  or  initials : 

4.  Sex 5.  Age 


6.  Single  or  married 

(If  female,  state  whether  patient  had  children  or  miscarriages) 

7..  Race  or  nationality.-. - 

(Australioid  [Coolies  of  East  India],  Negroid  [Negroes,  Negritos  of  the  Philippines], 
Mongoloid    [Chinese,    Japanese,    American    Indians,    Philippinoes],  Melanochroic 
[Italians,  Spaniards,  Greeks,  Arabs,  Jews],  Xanthochroic  [Fair  Europeans]. 
State  not  only  the  name  of  the  race,  but  also  of  the  subdivision) 

8.  Place  of  birth 

(State  not  only  the  country  but  also  the  town  or  village  where  the  patient  was  born) 

9.  Residence,  etc 


10.  Occupation 

(Pay  special  attention  to  occupation,  involving  use  of  chemical  [anilin,  paraffin,  tar,  etc.], 
"physical  [X-rays,   radium,  excessive  heat,   electricity,  etc.],  or  mechanical  irritants) 

11.  Diet 


(State  whether  the  diet  is  composed  chiefly  of  vegetables,  fresh  fish,  fresh  meat,  salted  fish,  salted  meat) 

12.  Habitual  use  of  drugs 

(Alcohol,  tobacco  [chewing,  smoking  pipe  or  cigar],  opium  [opium  smoking  or  morphium  injection],  cocaine) 

13.  Previous  general  diseases _ 

{Tuberculosis,  Lepra,  Arteriosclerosis,  Syphilis,  Gonorrhoea,  etc.) 


1 4 .  When  were  the  first  symptoms  of  the  disease  observed  ? . 


15.  On  what  data  or  symptoms  was  the  diagnosis  made.'* . 

(If  the  diagnosis  was  made  at  an  operation,  auto] 
state  the  exact  anatomic 

16.  What  organ  was  primarily  involved? 


(If  the  diagnosis  was  made  at  an  operation,  autopsy  or  microscopically,  specify  so  and 
state  the  exact  anatomical  diagnosis) 


294 


APPENDIX  B 

Table  5  (concluded) 
Question  Form  of  the  George  Crocker  Special  Research  Fund 


17.  Was  the  same  organ  previously  diseased  or  subjected  to  trauma? 

(As  instances  of  such  previous  local  diseases  important  in  the  study  of  the  etiology  of 

cancer  may  be  mentioned  leucoplasia  of  the  tongue,  mastitis,  lupus  of  the  face,  ndevi,  scars 

or  leprous  nodules  of  the  skin,  gallstones,  round  ulcer  of  the  stomach,  varicose  ulcers,  old 

fractures  of  hones  [osteo-sarcoma],  etc.) 

18.  What  organs  became  subsequently  affected? 

19.  Did  any  other  tumor  develop  on  the  same  patient? 

20.  Were  there  any  other  cases  of  cancer  in  the  patient's  family? 

(The  family  may  mean  grandparents,  parents,  brothers  and  sisters,  man  or  wife,  children. 
State  relationship  to  patient  and  organ  primarily  involved) 

21.  Were  there  any  other  cases  of  cancer  in  the  same  house  or  neighbor- 

hood?  

(State  time,  place,  and  organ  primarily  involved) 

22.  Was  there  a  retrogression  of  the  tumor? 

(After  treatment — operation,  X-ray,  radium,  fulguration — or  spontaneously) 

Remarks 


The  sources  of  cancer  mortality  data  are  briefly  discussed  in  Chapter  II. 

295 


APPENDIX  B 

Table  6 
Uterine  Cancer  Blank  of  the  American  Society  for  the  Control  of  Cancer 

A.  S.  C.  C— Uterine  Cancer  Form— Sheet  No.  1. 

GENERAL  MEMORIAL  HOSPITAL 

Ward Room History  No Diagnosis 

Name Complications 

Address . Result 

(Married.  Single.  Widowed.)  Admitted 191 

Age Discharged 191 

House  Surgeon Attending  Surgeon 

Personal  Data       Race Nationality Birthplace 

Occupation  (work  actually  done) ' 

Family  History 

(Members  with  cancer  or 
other  uterine  diseases) 

Causes  of  death  in  family 

Personal  History 

(Note  previous  illnesses) 


Uterine  History 

Menstruation :     Onset Last Type. 

Recent  data 

Gestations:    Number Date  of  first last. 

Character  of  labors 

Abortions 

(Date;  report) 

Operations 

Other  uterine  data 

Present  Illness 

First  symptoms  (date,  etc.) 

Hemorrhage 

Pain 

Change  in  discharge 

Description  of  tumor 

Exact  location 

Form 

Size 

Mobility 

Parametrium 

Lymph  nodes 

Vagina 

Bladder 

Rectum 

296 


APPENDIX  B 

Table  6  (concluded) 
Uterine  Cancer  Blank  of  the  American  Society  for  the  Control  of  Cancer 


A.  S.  C.  C. — Uterine  Cancer  Form — Sheet  No.  2. 

GENERAL  MEMORIAL  HOSPITAL 
Operative  History 

(State  exact  tissues  removed) 


Later  History 

Recurrences 

Local 

Regional 

Remote 

Cachexia 

Cause  of  death 

Present  condition  (date) 

Pathological  Report 

Gross: 

Cervix 

Fundus 

Parametrium 

Vagina 

Microscopical :     (give  details  of  structure) . 

Epidermoid  carcinoma 

Adenocarcinoma 

Carcinoma 

Sarcoma 

Chorioma 

Autopsy  Report    (date) 

Recurrence 

Local 

Regional 

Remote 

Other  Data 


Note. — This  blank  was  prepared  under  the  direction  of  a  special  committee  of  the  American  Society  for 
the  Control  of  Cancer,  Dr.  James  Ewing,  chairman,  and  recommended  for  universal  adoption. 


297 


APPENDIX  B 

Table  7 

Buccal  Cavity  Cancer  Blank  of  the  American  Society 

for  the  Control  of  Cancer 


A.  S.  C.  C— Form  S4— First  Sheet  (BUCCAL,  LABIAL,  LINGUAL,  TONSILLAR  CANCER) 

GENERAL  MEMORIAL  HOSPITAL 

Ward Room History  Xo Diagnosis 

Name Complications 

Address Result 

(Alarried.  Single.  Widowed.)  Admitted 191 

Age Discharged 191 

House  Surgeon Attending  Surgeon 

Personal  Data     Race Nationality Birthplace 

Occupation  (state  exact  kind  of  work  performed) 

Family  History 

(Members  with  cancer  or 
other  buccal  diseases) : 

Causes  of  death  in  family 

Personal  History 

(Note  pre%'ious  illnesses) 


Buccal  History 

Conformation  of  lips,  tongue,  tonsils 

Alcohol Tobacco - 

Dental  history-  and  condition 

Nasal  history 

Aural  historv' 

Tonsillar  historj' 

Syphilis :  Leukoplakia 

Trauma 

Present  Illness 

First  symptoms  (date,  etc.) 

General  Status 

Description  of  tumor 

Exact  location 

Form 

Size 

Depth 

Mobility 

Ulceration 

Lymph  nodes 

Bone  invasion 

Blood  vessels 

298 


APPENDIX  B 

Table  7  (concluded) 

Buccal  Cavity  Cancer  Blank  of  the  American  Society 

for  the  Control  of  Cancer 

A.  S.  C.  C— Form  S4— Second  Sheet  (BUCCAL,  LABIAL,  LINGUAL,  TONSILLAR  CANCER) 

GENERAL  MEMORIAL  HOSPITAL 

Operative  History 

(State  exact  tissues  removed  or  treatment) 


Later  History 

Recurrences 

Local 

Regional !. 

Remote 

Cachexia 

Sepsis 

Cause  of  death 

Present  condition  (date) 4. 

Pathological  Report 

Gross : 

Type  of  ulcer 

Infiltration 

Suppuration 

Outlying  mucosa 

Lymph  nodes 

Microscopical :     (give  details  of  structure) 

Epidermoid  carcinoma 

Adenocarcinoma 

Glandular  Carcinoma 

Basal  cell  carcinoma 

Autopsy  Report      (date) 

Recurrence 

Local 

Regional 

Remote 

Other  Data 


Note. — This  blank  was  prepared  under  the  direction  of  a  special  committee  of  the  American  Society  for 
the  Control  of  Cancer,  Dr.  James  Ewing,  chairman,  and  recommended  for  universal  adoption. 


299 


APPENDIX  B 

Table  8 
Mammary  Cancer  Blank  of  the  American  Society  for  the  Control  of  Cancer 

A.  S.  C.  C— Form  S2— First  Sheet  (MAMMARY  CANCER) 

GENERAL  MEMORIAL  HOSPITAL 

Ward Room History  No Diagnosis 

Name Complications 

Address Result 

(Married.  Single.  Widowed.)  Admitted 191 

Age ,  Discharged 191 

House  Surgeon Attending  Surgeon 

Personal  Data    Race Nationality Birthplace 

Occupation  (state  exact  kind  of  work  performed) 

Family  History 

(Members  with  cancer  or 
other  mammary  diseases) 

Causes  of  death  in  family 

Personal  History 

(Note  previous  illnesses) 

Mammary  History 

Type  of  gland :    Large Small Adipose 

Lactations:     Number Date  of  first Last 

Duration Flow  of  milk 

Character  of  Nipples 

Mastitis Cysts Nodules 

Abscess  and  residual  induration 

Trauma Date Location 

Character 

Previous  Tumor 

State  of  other  Breast 

Present  Illness 

(First  symptoms,  character  and  date) 

Pain 

Nutrition :    Anemia 

Description  of  Tumor 

Exact  location 

Form 

Size  (cm.) 

Nipple:    Retraction Fixation Discharge 

Skin :     Fixation Surface 

Mobility 

Mobility  of  Muscle 

Lymph  nodes :     Axillary 

Epigastric Supraclavicular 

Rate  of  Growth 

300 


APPENDIX  B 

Table  8  (concluded) 
Mammary  Cancer  Blank  of  the  American  Society  for  the  Control  of  Cancer 

A.  S.  C.  C— Form  S2— Second  Sheet  (MAMMARY  CANCER) 

GENERAL  MEMORIAL  HOSPITAL 

Operative  History 

(State  exact  tissues  removed) 


Later  History 

Recurrences 

Local 

Regional 

Remote 

Cachexia 

Cause  of  Death 

Present  condition  (date) 

Pathological  Report 

Gross : 

Lymph  nodes 

Muscle 

Skin 

Fascia  between  muscle  and  breast 

Microscopical :  (give  details  of  structure) . 

Adenoma 

Adenocarcinoma 

alveolar 


{: 


Carcinoma  ,    ,.„ 

(^  dinuse . 

Sarcoma 

Remainder  of  breast 

Autopsy  Report     (date). 

Recurrence 

Local 

Regional 

Remote 

Bones 

Mode  of  extension 


Note. — This  blank  was  prepared  under  the  direction  of  a  special  committee  of  the  American  Society  for 
the  Control  of  Cancer,  Dr.  James  Ewing,  chairman,  and  recommended  for  universal  adoption. 

301 


APPENDIX  B 

Table  9 
Gastric  Cancer  Blank  of  the  American  Society  for  the  Control  of  Cancer 

A.  S.  C.  C— Form  S3— First  Sheet  (GASTRIC  CANCER) 

GENERAL  MEMORIAL  HOSPITAL 

Ward Room History  No Diagnosis 

Name Complications 

Address Result 

(Married.  Single.  Widowed.)  Admitted 191 

Age Discharged 191 

House  Surgeon Attending  Surgeon 

Personal  Data     Race Nationality Birthplace 

Occupation  (State  exact  kind  of  work  performed) 

Family  History 

(Members  with  cancer  or 
other  gastric  diseases) 

Ca;uses  of  death  in  family 

Personal  History 

(Note  previous  illnesses  including  all  signs  of  tumors) 


Alcoholism 

Usual  state  of  nutrition 

Gastric  History 

Attacks  of  gastritis l 

Indigestion:    Pain Time  of  onset Mode  of  relief. 

Athletic  Stomach.'* 

Jaimdice 

Signs  of  ulcer 

Favorite  diets 

Gastric  analysis  (old) . 

Trauma 

Present  Illness 

(Give  first  symptoms,  date,  etc.) 

Any  definite  cause 

Were  early  signs  persistent 

Pain:    Time  of  onset Modeof  relief 

Vomiting  and  vomitus 

Local  tumor 

Loss  of  weight  (date,  etc.) 

Gastric  analyses 

Stools  (Gross  and  Mx.) 

Gastroscopic  signs 

X-Ray 

General  status 


302 


APPENDIX  B 

Table  9  (concluded) 
Gastric  Cancer  Blank  of  the  American  Society  for  the  Control  of  Cancer 

A.  S.  C.  C— Form  S3— Second  Sheet  (GASTRIC  CANCER) 

GENERAL  MEMORIAL  HOSPITAL 
Operative  History 

(State  exact  tissues  removed  or  involved) 

Anastomosis 

Fistula 


Later  History 

Digestion 

Nutrition 

Recurrence 

Local 

Regional 

Remote 

Cachexia 

Cause  of  Death 

Present  condition  (date) 

Pathological  Report 

Gross : 

Pylorus 

Fundus 

Cardia 

Peritoneum 

Lymph  nodes 

Microscopical :  Adenocarcinoma  (give  details  of  structure) . 

Fibro-Carcinoma 

Diffuse  carcinoma 

Gelatinous  carcinoma 

Linitis  plastica 

Lymph  nodes 

Autopsy  Report     (date) 

Description  of  organ 

Recurrence 

Local 

Regional 

Remote 

Paths  of  dissemination 

Other  Data 


Note. — This  blank  was  prepared  under  the  direction  of  a  special  committee  of  the  American  Society  for 
the  Control  of  Cancer,  Dr.  James  Ewing,  chairman,  and  recommended  for  universal  adoption, 

303 

21 


APPENDIX  B 

Table  10 

Supplementary  Letter  of  Inquiry  on  Statistics  of  Cancer  of  the  Division  of 

Vital  Statistics  of  the  United  States  Census 


OFFICE   OF 

THE   DIRECTOR 


DEPARTMENT  OF  COMMERCE 

BUREAU  OF  THE  CENSUS 
WASHINGTON 


Dear  Doctor: 

At  the  request  of  the  American  Society  for  the  Control  of  Cancer  the 
Bureau  of  the  Census  has  decided  to  'publish  two  sets  of  statistics  covering 
the  subject  of  deaths  from  cancer  and  other  malignant  tumors: 

(a)  Statistics  of  deaths  in  which  the  diagnoses  were  based  on  clinical 
findings. 

(b)  Statistics  of  deaths  in  which  the  diagnoses  were  confirmed  by  autop- 
sies, or  in  which  surgical  operations  were  performed. 

Will  you  kindly  examine  the  accompanying  transcript  of  a  medical 
certificate  of  death,  the  original  of  which  was  made  out  by  you,  and  note 
thereon  whether  the  diagnosis  was  based  on  CLINICAL  FINDINGS 
or  AUTOPSY;  also  whether  there  was  SURGICAL  INTERVEN- 
TION? In  either  case  the  SEAT  OF  THE  DISEASE  should  also 
be  stated.  Any  further  data  which  you  care  to  give  may  be  written  on  the 
reverse  side  of  the  transcript. 

The  information  will  be  treated  as  strictly  confidential  and  used  for 
statistical  purposes  only.  I  feel  assured  that  your  interest  in  advancing 
the  scientific  study  of  this  subject  will  prompt  you  to  aid  the  Bureau  in  this 
great  work,  the  success  of  which  is  entirely  dependent  upon  the  cooperation 
of  American  physicians. 

Prompt  return  of  the  information  desired,  by  means  of  inclosed  penalty 
envelope  which  requires  no  postage,  will  be  greatly  appreciated,  as  2ve  are 
now  compiling  these  returns. 

Very  respectfully, 

SAM.  L.  ROGERS, 
Inclosures.  Director. 


304 


APPENDIX 

c 

Mortality  from  Cancer  in  Different  Occupations 


Table  Page 

1  England  and  Wales,  by  Age,  Males,  1890-1892 306 

2  England  and  Wales,  by  Age,  Males,  1900-1902 308 

3  England  and  Wales,  Crude  and  Standardized  Rates,  Ages  15  and  over.  Males, 

1890-1892 310 

4  England  and  Wales,  Crude  and  Standardized  Rates,  Ages  15  and  over.  Males, 

1900-1902 311 

5  England  and  Wales,  Males,  Standardized  Rates,   1890-1892  Compared  with 

1900-1902 312 

6  Industrial  Experience  of  The  Prudential  Insurance  Company  of  America,  Per 

Cent,  of  All  Causes,  Ages  35  and  over,  1907-1912 313 

7  Hungary,  1904,  Cancer  Census  of  Cases,  Ages  15  and  over.  Males 315 

8  Hungary,  1901-1904,  Death  Rates,  Ages  15  and  over,  Males 315 


305 


APPENDIX  C 

Table  1 

Mortality  from  Cancer  in  England  and  Wales  in  Selected  Occupations 

according  to  Age,  Males,  1890-1892 


All  males . 


35-44  YEARS  OF  AGE 

Deaths      Rate  per 
No.  of  Persons      from         100,000 
Cancer    Population 

.  4,833,231       1,769         36.6 


Occupied  males 4,714,230  1,644  34.9 

Occ.  males,  industrial  dists. . .  1,072,512  422  39.3 

Occ.  males,  agricultural  dists.  641,097  204  31.8 

Unoccupied  males 119,001  125  105.0 

Clergymen 26,256  8  30.5 

Lawyers 16,587  7  42.2 

Physicians 14,481  3  20.7 

School-teachers 23,994  6  25.0 

Domestic  indoor  servants.  . .  21,588  4  18.5 

Ry.  eng.  drivers  and  stokers  24,819  4  16.1 

Seamen 68,172  33  48.4 

Farmers  and  graziers 140,472  43  30.6 

Farmlaborers 311,364  105  33.7 

Gardeners  and  nurserymen . .  90,810  27  29.7 

Tobacconists 8,451  4  47.3 

Fishermen 13,965  4  28.6 

Maltsters...." 6,261  5  79.9 

Brewers 18,069  10  55.3 

Innkeepers 62,094  27  43.5 

Grocers 58,374  14  24.0 

Coal-merchants 18,699  7  37.4 

Ironmongers 10,338  6  58.0 

Printers 34,926  16  45.8 

Butchers 46,926  28  59.7 

Corn-millers 12,756  7  54.9 

Bakers 42,981  19  44.2 

Hatters 8,727  2  22.9 

Tailors 61,002  21  34.4 

Shoemakers 96,321  42  43.6 

Tanners 6,402 

Metal-workers 405,633  156  38.5 

Carpenters  and  joiners 139,701  41  29.3 

Textile-workers 175,263  57  32.5 

Potters 17,061  2  11.7 

Glass-workers 11,634  6  51.6 

Coal-miners 265,098  61  23.0 

Quarrymen 33,120  16  48.3 

Gas-works  service 25.053  16  63.9 

Chimney-sweeps 5,634  7  124.2 


45-54   YEARS  OF  AGE 

Deaths     Rate  per 
No.  of  Persons      from        100,000 
Cancer  Population 

3,575,367   4,204   117.6 


3,426,093 
732,954 
528,117 
149,274 

23.487 

9,537 

9,840 

15,093 

12,684 

11,433 

48,240 

141,129 

284,427 

80,409 

5,481 

9,510 

5,019 

12,633 

56,034 

42,891 

16,212 

6.828 

19.530 

29,931 

10,263 

29,898 

5,010 

47,943 

87,405 

4,761 

278,109 

105,012 

121,398 

11,451 

6,876 

162,981 

24,045 

15,654 

3,945 


3,856 


112.5 
902  123.1 
479  90.7 
348   233.1 


19 

19 

10 

12 

14 

12 

64 

112 

245 

71 

10 

14 

7 

24 

73 

30 

19 

1 

21 

33 

10 

33 

3 

58 

108 

4 

333 

105 

133 

12 

12 

129 

41 

22 

21 


80.9 
199.2 
101.6 

79.5 
110.4 
105.0 
132.7 

79.4 

86.1 

88.3 
182.4 
147.2 
139.5 
190.0 
130.3 

69.9 
117.2 

14.6 
107.5 
110.3 

97.4 
110.4 

59.9 
121.0 
123.6 

84.0 
119.7 
100.0 
109.6 
104.8 
174.5 

79.2 
170.5 
140.5 
532.3 


Source:     Supplement  to  the  Fifty-fifth  Report  of  the  Registrar-General  of  England 
and  Wales,  1881-1890,  Vol.  II. 


306 


APPENDIX  C 


Table  1  (concluded) 

Mortality  from  Cancer  in  England  and  Wales  in  Selected  Occupations 

according  to  Age,  Males,  1890-1892 


55-64  YEARS  OF  AGE 

Deaths  Rate  per 

No.  of  Persons  from  100,000 

Cancer  Population 

All  males 2,310,372  6,381  276.2 

Occupied  males 2,072,076  5,408  261.0 

Occ.  males,  industrial  dists...  394,914  1,080  273.5 

Occ.  males,  agricultural  dists.  386,241  949  245.7 

Unoccupied  males 238,296  973  408.3 

Clergymen 17,556  34  193.7 

Lawyers 5,913  19  321.3 

Physicians 5,562  16  287.7 

School-teachers 6,435  17  264.2 

Domestic  indoor  servants 6,105  14  229.3 

Ry.  eng.  drivers  and  stokers  4,098  14  341.6 

Seamen 21,699  81  373.3 

Farmers  and  graziers 124,830  286  229.1 

Farm  laborers 244,245  512  209.6 

Gardeners  and  nurserymen .  .  64,407  145  225.1 

Tobacconists 3,384  8  236.4 

Fishermen 6,003  15  249.9 

Maltsters.: 2,607  8  306.9 

Brewers 6,576  27  410.6 

Innkeepers 33,117  103  311.0 

Grocers 29,580  65  219.7 

Coal-merchants 11,895  27  227.0 

Ironmongers 3,957  13  328.5 

Printers 8.874  24  270.5 

Butchers 16,134  62  384.3 

Corn-millers 6,618  18  272.0 

Bakers 17,628  47  266.6 

Hatters 2,688  10  372.0 

Tailors 35,280  96  272.1 

Shoemakers 63,036  184  291.9 

Tanners 2,868  8  278.9 

Metal-workers 139,524  384  275.2 

Carpenters  and  joiners 60,774  177  291.2 

Textile-workers 74,013  185  250.0 

Potters 5,031  11  218.6 

Glass-workers 2,994  7  233.8 

Coal-miners 80,403  201  250.0 

Quarrymen 13,185  41  311.0 

Gas-works  service 6,771  23  339.7 

Chimney-sweeps 2,151  17  780.S 


65  YEARS 

AND  OVER 

Deaths 

Rate  per 

o.  of  Persons 

from 

100.000 

Cancer  Population 

1,819,764 

8,401 

461.7 

1,178,679 

5.726 

485.8 

166,317 

762 

458.2 

292,242 

1.443 

493.8 

641.085 

2.675 

417.3 

16,017 

70 

437.0 

4,260 

16 

375.6 

5,676 

37 

651.9 

2,235 

11 

492.2 

2,604 

22 

844.9 

693 

5 

721.5 

8,631 

76 

880.5 

106,392 

516 

485.0 

202,401 

861 

425.4 

50,121 

223 

444.9 

1,266 

6 

473.9 

4.056 

32 

789.0 

1,134 

8 

705.5 

2,688 

18 

669.6 

14,877 

84 

564.6 

18,099 

61 

337.0 

6,579 

39 

592.8 

1,851 

9 

486.2 

3,645 

12 

329.2 

7,959 

46 

578.0 

3,333 

19 

570.1 

8,589 

37 

430.8 

1,599 

11 

687.9 

26,103 

113 

432.9 

44,589 

203 

455.3 

1,530 

6 

392.2 

56,937 

328 

576.1 

34,620 

183 

528.6 

37,149 

176 

473.8 

1.716 

9 

524.5 

1.044 

4 

383.1 

25.677 

105 

408.9 

5,475 

39 

712.3 

2,244 

21 

935.8 

1,125 

16 

1,422.2 

307 


APPENDIX  C 

Table  2 

Mortality  from  Cancer  in  England  and  Wales  in  Selected  Occupations 

according  to  Age,  Males,  1900-1902 


All  males . 


35-44  YEARS  OF  AGE 

Deaths     Rate  per 
No.  of  Persons       from         100,000 
Cancer    Population 

5,795,829       2,311         39.9 


Occupied  males 5,668,233  2,220  39.2 

Occ.  males,  industrial  dists...  1,511,544  687  45.5 

Occ.  males,  agricultural  dists.  784,014  220  28.1 

Unoccupied  males 127,596  91  71.3 

Clergymen 29,556  7  23.7 

Lawyers 19,686  8  40.6 

Physicians 21,405  9  42.0 

School-teachers 42,138  9  21.4 

Domestic  indoor  servants...  .  24,828  6  24.2 

Ry.  eng.  drivers  and  stokers  35,616  10  28.1 

Seamen 61,335  46  75.0 

Farmers  and  graziers 160,149  44  27.5 

Farm  laborers 263,655  80  30.3 

Gardeners  and  nurserymen . .  111,882  43  38.4 

Tobacconists 10,776  6  55.7 

Fishermen 14,940  4  26.8 

Maltsters 6,732  2  29.7 

Brewers 18,720  14  74.8 

Innkeepers 75,801  30  39.6 

Grocers 70,440  25  35.5 

Coal-merchants 21,756  3  13.8 

Ironmongers 13,893  3  21.6 

Printers 48,465  15  31.0 

Butchers 56,697  19  33.5 

Corn-millers 14,553  4  27.5 

Bakers 54,450  24  44.1 

Hatters 9,006  2  22.2 

Tailors.- 77,061  34  44.1 

Shoemakers 103,839  41  39.5 

Tanners 5,550  2  36.0 

Metal-workers 521,619  197  37.8 

Carpenters  and  joiners 147,279  56  38.0 

Textile-workers 200,073  95  47.5 

Potters 20,043  8  39.9 

Glass-workers 13,167  3  22.8 

Coal-miners 345,939  112  32.4 

Quarrymen 43,467  16  36.8 

Gas-works  service 38,718  10  25.8 

(Chimney-sweeps 5,079 6  118.1 


45-54  YEARS  OF  AGE 

Deaths     Rate  per 
No.  of  Persons       from       100,000 

Cancer  Population 

4,188,627   6,063   144.7 


4,024,074 

1,051,485 

610,221 

164,553 

25,275 
13,869 
12,366 
19,464 
14,625 
22,962 
43,698 
143,787 
215,895 
98,877 

7,614 
10,896 

4,752 
12,531 
61,086 
45,927 
18,183 

9,387 
28,542 
34,266 
10,665 
33,645 

6,306 
51,510 
77,217 

4,314 

371,985 

120,978 

130,515 

12,894 

9,030 

224,634 

33,705 

24,918 

4,536 


5,701 

1,621 

699 

362 

23 

22 

15 

24 

25 

21 

104 

146 

233 

92 

11 

19 

5 

30 

82 

51 

22 

6 

39 

48 

22 

49 

10 

79 

120 

2 

508 

161 

192 

21 

13 

232 

35 

37 

13 


141.7 
154.2 
114.5 
220.0 

91.0 
158.6 
121.3 
123.3 
170.9 

91.5 
238.0 
101.5 
107.9 

93.0 
144.5 
174.4 
105.2 
239.4 
134.2 
111.0 
121.0 

63.9 
136.6 
140.1 
206.3 
145.6 
158.6 
153.4 
155.4 

46.4 
136.6 
133.1 
147.1 
162.9 
144.0 
103.3 
103.8 
148.5 
286.6 


Source:     Supplement  to  the  Sixty-fifth  Report  of  the  Registrar-General  of  England 
and  Wales,  1900-1902.  Vol.  II. 


308 


APPENDIX  C 


Table  2  (concluded) 

Mortality  from  Cancer  in  England  and  Wales  in  Selected  Occupations 

according  to  Age,  Males,  1900-1902 


All  males . 


55-64  YEARS  OF  AGE 

Deaths       Rate  per 
No.  of  Persons      from         100,000 
Cancer    Population 

.   2,723,835       9,867      362.2 


Occupied  males 

Occ.  males,  industrial  dists. . . 
Occ.  males,  agricultural  dists. 
Unoccupied  males 

Clergymen 

Lawj'ers 

Physicians 

School-teachers 

Domestic  indoor  servants.. . . 
Ry.  eng.  drivers  and  stokers 

Seamen 

Farmers  and  graziers 

Farm  laborers 

Gardeners  and  nurserymen .  . 

Tobacconists 

Fishermen 

Maltsters 

Brewers 

Innkeepers 

Grocers 

Coal-merchants 

Ironmongers 

Printers 

Butchers 

Corn-millers 

Bakers 

Hatters 

Tailors 

Shoemakers 

Tanners 

Metal-workers 

Carpenters  and  joiners 

Textile-workers 

Potters 

Glass-workers 

Coal-miners 

Quarrymen 

Gas-works  ser%'ice 

Chimney-sweeps 


!,424,456 
575,952 
447,492 
299,379 

20,238 

6,741 

7,239 

9,789 

7,170 

8,739 

23,928 

126,306 

181,137 

79,524 

4,431 

7,035 

2,691 

6,744 

36,684 

29,961 

13,323 

5,190 

13,752 

17,688 

6,825 

19,653 

3,225 

34,008 

61,776 

2,559 

203,892 

78,063 

72,087 

6,408 

4,374 

107,454 

19,206 

12,393 

2,724 


8,027 
1,982 
1,243 
1,840 

61 

26 

31 

26 

24 

24 

118 

368 

416 

193 

9 

23 

10 

43 

133 

81 

30 

21 

47 

72 

24 

74 

11 

141 

210 

5 

720 

255 

259 

19 

14 

300 

59 

52 

18 


331.1 
344.1 

277.8 
614.6 

301.4 
385.7 
428.2 
265.6 
334.7 
274.6 
493.1 
291.4 
229.7 
242.7 
203.1 
326.9 
371.6 
637.6 
362.6 
270.4 
225.2 
404.6 
341.8 
407.1 
351.6 
376.5 
341.1 
414.6 
339.9 
195.4 
353.1 
326.7 
359.3 
296.5 
320.1 
279.2 
307.2 
419.6 
660.8 


65  YEARS  AND  OVER 

Deaths     Rate  per 
No.  of  Persons      from       100,000 
Cancer  Population 

1,983,216  12,658   638.3 


1,202,520 
218,604 
313,359 
780,696 

17,493 

4,296 

5,367 

2,082 

2,499 

1,257 

8,130 

101,595 

150,189 

60,837 

2,064 

3,990 

1,095 

2,535 

14,403 

16,806 

7,152 

2,601 

4,383 

7,230 

3,675 

8,844 

1,257 

22,530 

40,899 

1,185 

71,052 

38,382 

30,864 

2,055 

1,290 

30,003 

7,683 

3,798 

1,146 


8,038  668.4 

1,400  640.4 

2,118  675.9 

4,620  591.8 


102 

27 

31 

26 

16 

20 

109 

674 

825 

363 

16 

33 

9 

25 

116 

74 

52 

15 

28 

52 

20 

46 

9 

153 

256 

11 

539 

254 

261 

10 

12 

201 

56 

28 


583.1 
628.5 
577.6 
1,248.8 
640.3 
1,591.1 
1,340.7 
663.4 
549.3 
596.7 
775.2 
827.1 
821.9 
986.2 
805.4 
440.3 
727.1 
576.7 
638.8 
719.2 
544.2 
520.1 
716.0 
679.1 
625.9 
928.3 
758.6 
661.8 
845.6 
486.6 
930.2 
669.9 
728.9 
737.2 


19  1,657.9 


309 


APPENDIX  C 

Table  3 

Mortality  from  Cancer  in  England  and  Wales  in  Selected  Occupations,  Males, 

Crude  and  Standardized  Death  Rates,  Ages  15  and  Over,  1890-1892 


Recorded  Death  Standardized  Death 

Rate  from  Cancer  per  Standardizing     Rate  from  Cancer  per 

100,000  Population  Factor            100,000  Population 

All  males 80.5  1.0000  80.5 

Occupied  males 68.5  1.1467  78.5 

Occupied  males  in  industrial  districts ...  .  60.7  1.3350  81.0 

Occupied  males  in  agricultural  districts .  .  84.9  0.8866  75.3 

Unoccupied  males 276.8  0.3232  89.5 

Clergymen 122.3  0.5502  67.3 

Lawyers 101.8  0.8807  89.7 

Physicians 119.7  0.7638  91.4 

School-teachers 36.7  1.9398  71.2 

Domestic  indoor  servants 38.7  2.1129  81.8 

Railway  engine  drivers  and  stokers 31.8  2.2837  72.6 

Seamen 85.6  1.3262  113.5 

Farmers  and  graziers 120.3  0.6062  72.9 

Farm  laborers 80.7  0.8248  66.6 

Gardeners  and  nurserymen 93.4  0.7406  69.2 

Tobacconists 74.4  1.1697  87.0 

Fishermen 93.1  1.0849  101.0 

Maltsters 107.4  1.0160  109.1 

Brewers 106.7  1.1354  121.1 

Innkeepers 131.1  0.7105  93.1 

Grocers 46.8  1.2385  58.0 

Coal-merchants 115.2  0.7365  84.8 

Ironmongers 51.2  1.4073  72.1 

Printers 36.9  2.0942  77.3 

Butchers 64.1  1.5160  97.2 

Corn-millers 82.0  1.0075  82.6 

Bakers 55.5  1.4208  78.9 

Hatters 57.8  1.4583  84.3 

Tailors 84.0  0.9111  76.5 

Shoemakers 95.5  0.8697  83.1 

Tanners 62.6  1.0216  64.0 

Metal-workers 60.7  1.4049  85.3 

Carpenters  and  joiners 80.0  1.0037  80.3 

Textile-workers 54.1  1.3927  75.3 

Potters 37.6  1.6958  63.8 

Glass-workers 51.8  1.8660  96.7 

Coal-miners 36.3  1.6919  61.4 

Quarrymen 96.0  1.1145  107.0 

Gas-works  service 91.4  1.2452  113.8 

CTiimney-sweeps 265.9 0.9984 265.5 

Source:     Supplement  to  the  Fifty-fifth  Report  of  the  Registrar-General  of  England 
and  Wales,  1881-1890,  Vol.  II. 


310 


APPENDIX  C 

Table  4 

Mortality  from  Cancer  in  England  and  Wales  in  Selected  Occupations,  Males, 

Crude  and  Standardized  Death  Rates,  Ages  15  and  Over,  1900-1902 

Recorded  Death 
Rate  from  Cancer  per 
100,000  Population 

All  males 101.9 

Occupied  males 84.7 

Occupied  males  in  industrial  districts ....  77.1 

Occupied  males  in  agricultural  districts. . .  103.4 

Unoccupied  males 373.7 

Clergymen 163.1 

Lawyers 131.8 

Physicians 127.5 

School-teachers 52.5 

Domestic  indoor  servants 43.9 

Railway  engine  drivers  and  stokers 41.9 

Seamen 136.3 

Farmers  and  graziers 146.4 

Farm  laborers 96.6 

Gardeners  and  nurserymen 116.1 

Tobacconists 83.4 

Fishermen 115.0 

Maltsters 94.2 

Brewers 137.7  ■ 

Innkeefjers 144.6 

Grocers 56.3 

Coal-merchants 115.0 

Ironmongers 64.0 

Printers 50.8 

Butchers 63.0 

Corn-millers 107.9 

Bakers 69.2 

Hatters 74.0 

Tailors 104.6 

Shoemakers 113.3 

Tanners 70.9 

Metal-workers 73.2 

Carpenters  and  joiners 93.4 

Textile-workers 81.8 

Potters 56.8 

Glass-workers 59.5 

Coal-miners 50.3 

Quarrymen 80.8 

Gas-works  service 93.7 

Chimney-sweeps 280.6 

Source:    Supplement  to  the  Sixtv-fifth  Report  of  the  Registrar-General  of  England 
and  Wales,  1900-1902,  Vol.  II. 


Standardizing 
Factor 

Standardized  Death 
Rate  from  Cancer  per 
100,000  Population 

1.0185 

103.8 

1.1919 

101.0 

1.3341 

102.9 

0.8921 

92.2 

0.3207 

119.8 

0.5353 

87.3 

0.8486 

111.8 

0.7928 

101.1 

1.7157 

90.1 

2.1240 

93.2 

2.0349 

85.3 

1.2508 

170.5 

0.6477 

94.8 

0.8254 

79.7 

0.7336 

85.2 

1.1438 

95.4 

0.9728 

111.9 

1.0782 

101.6 

1.2101 

166.6 

0.7521 

108.8 

1.3580 

76.5 

0.7456 

85.7 

1.3586 

87.0 

1.8295 

92.9 

1.6319 

102.8 

0.9758 

105.3 

1.4349 

99.3 

1.3653 

101.0 

1.0791 

112.9 

0.9109 

103.2 

1.1026 

78.2 

1.3815 

101.1 

1.0448 

97.6  - 

1.3770 

112.6 

1.6014 

91.0 

1.6958 

100.9 

1.6372 

82.4 

1.1289 

91.2 

1.1428 

107.1 

0.8016 

224.9 

311 


APPENDIX  C 

Table  5 

Mortality  from  Cancer  in  England  and  Wales  in  Selected  Occupations 

Males,  Ages  15  and  Over — Standardized  Death  Rates 

1890-1892  Compared  with  1900-1902 

Standardized  Death  Rates  from  Cancer  Increase  ner 

per  100,000  Population  jqO  000 

1890-1892                          1900-1902  PopuJation 

All  males 80.5                          103.8  23.3 

Occupied  males 78.5                          101.0  22.5 

Occupied  males  in  industrial  districts.  .  .  .     81.0                          102.9  21.9 

Occupied  males  in  agricultural  districts. . .     75.3                              92.2  16.9 

Unoccupied  males 89.5                           119.8  30.3 

Chimney-sweeps 265.5                          224.9  —40.6 

Brewers 121.1                           1G6.6  45.5 

Gas-works  service 113.8                           107.1  -  6.7 

Seamen.  .> 113.5                            170.5  57.0 

Maltsters 109.1                            101.6  -  7.5 

Quarrymen 107.0                            91.2  -15.8 

Fishermen 101.0                          111.9  10.9 

Butchers 97.2                          102.8  5.6 

Glass-workers 96.7                          100.9  4.2 

Innkeepers 93.1                           108.8  15.7 

Physicians 91.4                          101.1  9.7 

Lawyers 89.7                          111.8  22.1 

Tobacconists 87.0                            95.4  8.4 

Metal-workers '...     85.3                          101.1  15.8 

Coal-merchants 84.8                            85.7  0.9 

Hatters 84.3                          101.0  16.7 

Shoemakers 83.1                           103.2  20.1 

Corn-millers 82.6                            105.3  22.7 

Domestic  indoor  servants 81.8                            93.2  11.4 

Carpenters  and  joiners 80.3                            97.6  17.3 

Bakers 78.9                            99.3  20.4 

Printers 77.3                            92.9  15.6 

Tailors 76.5                          112.9  36.4 

Textile-workers 75.3                          112.6  37.3 

Farmers  and  graziers 72.9                            94.8  21.9 

Railway  engine  drivers  and  stokers 72.6                            85.3  12.7 

Ironmongers 72.1                              87.0  14.9 

School-teachers 71.2                            90.1  18.9 

Gardeners  and  nurserymen 69.2                            85.2  16.0 

Clergymen 67.3                            87.3  20.0 

Farm  laborers 66.6                            79.7  13.1 

Tanners 64.0                            78.2  14.2 

Potters 63.8                            91.0  27.2 

Coal-miners 61.4                             82.4  21.0 

Grocers 58.0 76^5 18.5 

Source:     Supplements  to  the  Fifty-fifth  and  Sixty -fifth  Reports  of  the  Registrar- 
General  of  England  and  Wales.  (1881-1890.  Vol.  II.,  and  1900-1902,  Vol.  II.) 


812 


APPENDIX  C 

Table  6 
Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company 

of  America 
Mortality  from  Cancer  by  Occupation,  Ages  35  and  Over,  Males,  1907-1912 


Deaths  from 
All  Causes 

All  males  (35  years  and  over) 133,175 

All  occupied  males  (35  years  and  over)..  121,637 

Unoccupied  Males 7,107 

Retired 4,197 

Farmers  and  planters 5,589 

Gardeners 1,210 

Fishermen  and  oystermen 255 

Coal-miners 2,171 

Potters 216 

Glass-workers 368 

Marble  and  stone- workers 675 

Clothing-workers  (tailors) 1,748 

Hatters 411 

Bakers 901 

Millers 173 

Iron-moulders 1,004 

All  other  iron  and  steel- workers 2,657 

Ship  and  boat  builders 227 

Wagon-makers  and  wheelwrights 422 

Harness-makers 322 

Tanners 266 

Brewers  and  maltsters 225 

Upholsterers 237 

Sawyers 183 

Coopers 643 

Jewelers 282 

Tinsmiths 596 

Papermakers 164 

Bookbinders 143 

Printers  and  lithographers 1,103 

Textile-workers 1,651 

Cigarmakers 838 

Electrical  workers 418 

Rubber-workers 132 

Blacksmiths 1,782 

Builders  and  contractors 537 

Carpenters 6,478 

Masons 2,088 

Painters 3,445 

Paperhangers 191 

Plasterers 507 

Roofers 200 

Shoemakers 2,073 

Boxmakers 129 

Engineers,  not  specified 1,797 

Firemen,  not  specified 670 

Foremen,  not  specified 655 

Laborers,  not  specified 28,949 

Machinists 2,367 

Mill  operatives,  no'v  specified 903 


•eaths  from 

Per  Cent. 

Cancer 

of  All  Causes 

7,295 

6.48 

6.756 

5.55 

320 

4.50 

211 

6.03 

388 

6.94 

102 

8.43 

17 

6.67 

81 

3.73 

5 

2.31 

21 

5.71 

36 

6.33 

131 

7.49 

16 

3.89 

57 

6.33 

6 

3.47 

54 

5.38 

134 

5.04 

17 

7.49 

30 

7.11 

19 

5.90 

16 

6.02 

13 

6.78 

20 

8.44 

14 

7.65 

39 

^1.07 

23 

<J.16 

28 

4.70 

10 

6.10 

8 

5..59 

36 

3.26 

103 

6.24 

52 

6.21 

10 

2.39 

8 

6.06 

124 

6.96 

33 

6.15 

416 

6.42 

131 

6.27 

148 

4.30 

4 

2.09 

36 

7.10 

•    7 

3.50 

121 

5.84 

7 

5.43 

142 

7.90 

36 

5.37 

34 

6.19 

1,512 

6.22 

139 

5.87 

49 

6.43 

313 


APPENDIX  C 

Table  6  (concluded) 
Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company 

of  America 
Mortality  from  Cancer  by  Occupation,  Ages  35  and  Over,  Males,  1907-1912 


Deaths  from 
All  Causes 

Plumbers  and  fitters 1,005 

Sea  captains  and  pilots 250 

Boatmen 360 

Sailors 208 

Longshoremen  and  stevedores 387 

Street-cleaners 188 

Hostlers  and  stablemen 822 

DrajTnen,  teamsters  and  drivers 5,781 

Street-railwa:y  employees 566 

Railroad  engineers  and  firemen 158 

All  other  railroad  employees 2,377 

Mail-carriers 154 

Insurance  agents 396 

Butchers  and  meat-dealers 1,359 

Coal-dealers 138 

Grocers 816 

Liquor-dealers 165 

Canvassers  and  collectors 619 

Peddlers 667 

Salesmen 1,594 

Undertakers 168 

Clerks,  bookkeepers,  etc 3,661 

Policemen 453 

Watchmen 2,336 

Clergj'men 125 

Editors  and  journalists 101 

Musicians 291 

Physicians 177 

Teachers 141 

Barbers 934 

Bartenders 1,161 

Coachmen  and  chauflFeurs 319 

Cooks 445 

Elevator-tenders 148 

Janitors 1,115 

Laundrj'men 116 

Porters 581 

Hotel-keepers 425 

Restaurant-keepers 259 

Saloon-keepers 873 

Waiters 468 


Deaths  from 

Per  cent. 

Cancer 

of  AH  Causes 

48 

4.78 

17 

6.80 

22 

6.11 

13 

6.25 

17 

4.39 

10 

5.32 

39 

4.74 

238 

4.12 

28 

4.95 

8 

5.06 

118 

4.96 

3 

1.95 

27 

6.82 

80 

5.89 

17 

12.32 

50 

6.13 

6 

3.64 

41 

6.62 

38 

6.70 

81 

6.08 

6 

3.57 

158 

4.32 

31 

6.84 

148 

6.34 

10 

8.00 

10 

9.90 

17 

5.84 

12 

6.78 

16 

11.35 

49 

5.25 

35 

3.01 

15 

4.70 

'       19 

4.27 

11 

7.43 

89 

7.98 

10 

8.62 

32 

5.51 

19 

4.47 

13 

5.02 

50 

5.73 

19 

4.06 

314 


APPENDIX  C 

Table  7 

Cancer  Census  of  Hungary,  1904 — Cases  of  Cancer,  by  Occupation,  Males 

Number  of  Males  Cancer  Cases 

over  15  Years  of  Age                          per  100,000 

Census  of  1900  Population 

Common  laborers 169,103  136.6 

Butchers  (employers) 11,242  115.7 

Commerce  (employers) 78,756  92.7 

Masons  (employers) 10,840  73.8 

Flour-millers  (employers) 12,097  66.1 

Innkeepers  (employers) 24,620  56.9 

Tailors  (employers) 25,122  47.5 

Commerce  (employees) 23,538  46.7 

Blacksmith  (employers) 33,860  41.3 

Transportation  (employees) 76,962  37.7 

Shoemakers  (employers) 57,433  34.8 

Carpenters  and  cabinet-makers  (employers) 45,892  32.7 

Domestic  servants 29,163  30.9 

Miners  and  smelters 48,756  30.8 

Public  service  (employees) 45,571  26.3 

Farmers  (small  farms) 1,953,621  22.6 

Waiters 443,383  12.0 

Flour  mills  (employees) 24,089  8.7 

Farm  laborers 908,503  5.9 

Shoemakers  (employees) 37,538  5.3 

Carpenters  and  cabinet-makers  (employees) ......         59,624  5.0 

Table  8 

Mortality  from  Cancer  in  Hungary,  by  Occupation,  Males,  1901-1904 

Number  of  Males  Deaths  from 

over  15  Years  of  Age  Cancer  per  100,000 

Census  of  1900  Population 

Farmers 14,356  238.6 

Innkeepers  (employers) ,  .        24,620  167.6 

Butchers  (employers) 11,242  129.0 

Commerce  (employers) 78,756  119.0 

Carpenters  and  cabinet-makers  (employers) 45,892  115.5 

Public  service  (employees) 45,571  114.7 

Tailors  (employers).. 25,122  114.5 

Shoemakers  (employers) 57,433  110.1 

Blacksmiths  (employers) 33,860  108.5 

Masons  (employers) 10,840  96.9 

Common  laborers 169,103  86.6 

Railways  (employees) 53,581  83.1 

Flour-millers  (employers) 12,097  76.5 

Masons  (employees) 44,954  60.1 

Farm  laborers 908,503  '                               54.7 

Commerce  (employees) 23,538  51.0 

Carpenters  and  cabinet-makers  (employees) 59,624  47.0 

Domestic  servants 29,163  44.6 

Flour  mills  (employees) 24,089  43.3 

Miners  and  smelters 48,756  42.0 

Farmers  (small  farms) 1,953,621  41.0 

Tailors  (employees) 23,139  32.4 

Waiters 443,383  26.0 

Blacksmiths  (employees) 65,242  24.9 

Source:  Ungarische  Statistische  Mitteilungen.  Neue  Serie,  19  Band.  Statistik 
der  Kreb.skranken  in  den  Landern  der  Ungarischen  Heiligen  Krone.  Von  Dr.  Julius 
Dollinger,  Budapest,  1908. 

315 


APPENDIX 

D 


Cancer  Mortality  Statistics  of  American  and 
Foreign  Life  Insurance  Companies 


Tablt 
1 
2 
3 

;   Period 
1891-1913 
1891-1913 
1909-1913 

4 

1909-1912 

5 

1909-1912 

6 

1909-1913 

7 

1909-1912 

8 
9 

1909-1913 
1909-1913 

10 

1909-1913 

11 

1909-1913 

12 

1909-1913 

13 

1909-1913 

14 

1909-1913 

15 

1909-1913 

16 

1909-1913 

17 

1909-1913 

18 
19 
20 

1891-1913 
1891-1913 
1886-1913 

The  Prudential  Insurance  Company  of  America 

Title  Page 

Industrial  Experience Persons 321 

Industrial  Experience By  Sex 322 

Industrial  Experience Proportion  to  All  Causes,  by- 
Age  and  Sex 323 

Industrial  Experience Sarcoma  and  Other  Forms  of 

Cancer,  by  Age 323 

Industrial  Experience Sarcoma  and  Other  Forms  of 

Cancer,  by  Age  and  Sex. .  .  .       324 

Industrial  Experience Cancer,  by  Organs  and  Parts 

and  Sex,  Average  Age  at 
Death 324 

Industrial  Experience Sarcoma,  by  Organs  and  Parts 

and  Sex,  Average  Age  at 
Death 325 

Industrial  Experience By  Sex  and  Single  Years  of  Life      326 

Industrial  Experience Buccal  Cavity,  by  Sex   and 

Single  Years  of  Life 328 

Industrial  Experience Stomach  and  Liver,   by  Sex 

and  Single  Years  of  Life ....       330 

Industrial  Experience Peritoneum,    Intestines    and 

Rectum,  by  Sex  and  Single 
Years  of  Life 332 

Industrial  Experience Female  Generative  Organs,  by 

Single  Years  of  Life 334 

Industrial  Experience Breast,    by    Sex   and    Single 

Years  of  Life 335 

Industrial  Experience Skin,  by  Sex  and  Single  Years 

of  Life 337 

Industrial  Experience Other  or  Not  Specified  Organs, 

by  Sex  and  Single  Years  of  Life      339 

Industrial  Experience By  Organs  and  Parts  and  Sex, 

at  Divisional  Periods  of  Life.        341 

Industrial  Experience At  Divisional  Periods  of  Life, 

by  Organs  and  Parts,  accord- 
ing to  Sex 343 

Ordinary  Experience Persons 344 

Ordinary  Experience By  Sex 345 

Ordinary  Experience By  Age  and  Sex 346 

316 


APPENDIX  D 

The  Prudential  Insurance  Company  ok  America  (concluded) 

Table         Period  Title  Page 

21  1886-1913       Ordinary  Experience By  Organs  and  Parts  and  Sex, 

Average  Age  at  Death 346 

22  1886-1913       Ordinary  Experience By  Organs  and  Parts  and  Sex, 

at  Divisional  Periods  of  Life .       347 

23  1886-1913      Ordinary  Experience At  Divisional  Periods  of  Life, 

by  Organs  and  Parts,  accord- 
ing to  Sex  348 

24  1886-1913       Ordinary  Experience By    Organs    and    Parts    at 

Single  Years  of  Life,  Males. . .       350 

25  1886-1913       Ordinary  Experience By     Organs    and    Parts    at 

Single  Years  of  Life,  Females      352 

26  1886-1912       Ordinary  Experience . By  Weight  and  Age  at  Entry, 

Males 354 

27  1886-1912       Ordinary  Experience Family  History,  Cancer  and 

Tuberculosis  Compared 355 

Other  American  Companies 
Company- 
American  Companies According  to  Build,  Males . .  356 

American  Companies By  Duration  of  Policy  and  Age 

at  Entry 356 

Twenty-seven  American  Com- 
panies   By  Age  and  Sex 357 

iEtna Persons 358 

MutualLifeof  New  York By  Age  and  Sex 359 

Mutual  Life  of  New  York By  Age  and  Sex 359 

Mutual  Life  of  New  York Other  Tumors,  by  Age  and  Sex  360 

New  York  Life Persons 360 

Northwestern  Mutual  Life By  Age,  Males 361 

Washington  Life . . ' By  Age 361 

Foreign  Companies 

Thirty-four  Foreign  Companies .  .  Comparative    Statement    by 

Countries 361 

Thirty-four  Foreign  Companies .  .  By  Individual  Companies. . . .       362 

English  Companies 

British  Empire  Mutual  Life Cancer  and  Tumor,  by  Age. . .  363 

British  Empire  Mutual  Life Cancer  and  Tumor,  by  Age. . .  364 

Clergy  Mutual By  Age 364 

Clergy  Mutual By  Age,  Unhealthy  Lives . . .  365 

Equitable  Society By  Age 365 

Gresham  Life Cancer  and  Tumor,  by  Age. . .  366 

Metropolitan  Life  Assurance. .  .Cancer  and  Tumor,  by  Age. . .  366 

Prudential  Assurance Cancer,  by  Age  and  Sex 367 

Prudential  Assurance Tumor,  by  Age  and  Sex 367 

Prudential  Assurance By  Age  and  Organs  and  Parts, 

Males 368 

Prudential  Assurance By  Age  and  Organs  and  Parts, 

Females 369 

317 


28 

1885-1908 

29 

1885-1908 

30 

Up  to  1873 

31 

1870-1913 

32 

1843-1914 

33 

1843-1914 

34 

1843-1898 

35 

1901-1913 

36 

1857-1909 

37 

1860-1886 

38 

39 

40 

1847-1872 

41 

1873-1878 

42 

1829-1887 

43 

1829-1887 

44 

1801-1832 

45 

Up  to  1866 

46 

1835-1864 

47 

1867-1870 

48 

1867-1870 

49 

1867-1870 

60 

1867-1870 

Table 

Period 

51 

1826-1860 

52 

1826-1860 

53 

1826-1860 

54 

1826-1860 

55 

1912 

56 

1815-1845 

57 

1846-1852 

58 

1853-1859 

59 

1874-1880 

1888-1894 

60 

1874-1880 

1881-1887 

1888-1894 

61 

1874-1894 

62 

1874-1894 

APPENDIX  D 

Scotch  Companies 

Company                                                           Title  Page 

Scottish  Amicable  Life By  Age 370 

Scottish  Amicable  Life Cancer,  by  Age  and  Sex,  Non- 
hazardous  Occupations 370 

Scottish  Amicable  Life Tumor,  by  Age  and  Sex,  Non- 
hazardous  Occupations 371 

Scottish  Amicable  Life By  Age,  Hazardous  Occupa- 
tions    371 

Scottish  Union  and  National ....  By  Organs  and  Parts 372 

Scottish  Widows'  Fund Cancel"  and  Tumor,  by  Age .  .  372 

Scottish  Widows'  Fund Cancer  and  Tumor,  by  Age .  .  373 

Scottish  Widows"  Fund .........  Cancer  and  Tumor,  by  Age .  .  373 

Scottish  Widows' Fund Comparative  Statement,   ac- 
cording to  Age 374 

Scottish  Widows'  Fund Comparative  Statement,   ac- 
cording to  Age 374 

Scottish  Widows'  Fund Internal  and  External  Organs, 

Males 375 

Scottish  Widows'  Fund Internal  and  External  Organs, 

Based  upon  Number  of  Lives 

Exposed  to  Risk,  Males 376 

63     Up  to  1860     British  and  German  Companies .  Comparative  Statement 376 

German  Companies 

German  Companies Combined  Experience 376 

"Deutscher  Kriegerbund" By  Organs 377 

German  Life  Insurance  Com- 
pany, Potsdam By  Age 377 

"Freia,"  Hanover By  Age 377 

"Friedrich    Wilhelm,"    Ordi- 
nary Experience Persons 378 

"Friedrich    Wilhelm,"    Ordi- 
nary Experience By  Organs  and  Parts,  accord- 
ing to  Sex  379 

"Friedrich    Wilhelm,"     Ordi- 
nary Experience By  Age  and  Sex 379 

"Friedrich   Wilhelm,"   Indus- 
trial Experience By  sex 380 

"Friedrich  Wilhelm,"  Indus- 
trial Experience By  Organs  and  Parts  and  Sex      381 

"Friedrich   Wilhelm,"   Indus- 
trial Experience By  Age  and  Sex 381 

German  Life  Insurance  Com- 
pany, LUbeck By  Sex 382 

"Germania" By  Age  and  Sex,  Based  upon 

Number  of  Lives  Exposed  to 

Risk 382 

Gotha  Life  Insurance By  Age,  Males 383 

Gotha  Life  Insurance By  Age  and  Duration  of  Insur- 
ance,  Males 383 

Gotha  Life  Insurance By  Age 384 

Gotha  Life  Insurance By  Age,  among  Teachers. .  . .       385 

318 


64 

1899-1912 

65 

1908-1911 

66 

1907-1912 

67 

1907-1913 

68 

1885-1913 

69 

1885-1899 

70 

1885-1899 

71 

1885-1899 

72 

1885-1899 

73 

1885-1899 

74 

1906-1913 

75 

1857-1894 

76 

1829-1878 

77 

1829-1890 

78 

1903-1912 

79 

1829-1890 

APPE\DrX  D 

German  Companies  (concluded) 

Cjmpany                                                        Title  Page 

Karlsruhe  Life  Insurance Persons 385 

Karlsruhe  Life  Insurance By  Organs  and  Parts,  accord- 
ing to  Age 386 

Karlsruhe  Life  Insurance By  Organs  and  Parts 386 

Karlsruhe  Life  Insurance By  Age 387 

Leipzig  Life  Insurance By   Sex 387 

Leipzig  Life  Insurance By  Age,  Males 388 

Magdeburg  Life  Insurance Persons 388 

Magdeburg  Life  Insurance By  Age 388 

Saxon    Military  Life  Insur-         By  Organs  and  Parts,  accord- 
ance   ing  to  Sex 389 

Stuttgart  Life  Insurance By  Age 389 

Teutonia  Insurance By  Age 389 

"Victoria,"  Berlin Persons 390 

Austrian  Companies 

Austrian  Companies Persons 390 

Austrian  Companies By  Age 391 

Austrian  Companies Comparative   Statement,    by 

Age 391 

Austrian  Companies Probability    of    Death    from 

Cancer,  according  to  Age ....  392 

"Der  Anker,"  Vienna By  Age 392 

"Assicurazioni  Generali,"  Trieste .  Persons 392 

" Assicurazioni  Generali,"  Trieste .  By  Age 393 

"Donau,"  Vienna By  Age 393 

First  General  Association  of 

Austro-Hungarian  Officials By  Age 393 

"Janus,"  Vienna By  Age 393 

Life   Insurance   Company   of 
the  "Margraviate  Moravia," 

Briinn By  Age 394 

Mutual  Life  Insurance  Com- 
pany, Krakau By  Age 394 

"Phoenix,"  Vienna Persons 394 

"Phoenix,"  Vienna By  Age 395 

"Praha,"  Prague By  Age 395 

"Riunione  Adriatica  Sicurta" ....  By  Age 395 

"Universale,"  Vienna By  Age 396 

Hungarian  Companies 

"Fonciere,"  Budapest By  Age 396 

Swiss  Companies 

The  Basle  Life  Insurance Persons,  by  Sex 396 

"La  Suisse,"  Lausanne By  Age 396 

Swedish  Companies 

112     1873-1902       "Thule,"  Stoclvholm Persons 397 

319 

22 


Table 

Period 

80 

1910-1913 

81 

1910-1913 

82 

1900-1905 

83 

1900-1905 

84 

1893-1913 

85 

1893-1912 

86 

1901-1913 

87 

1901-1913 

88 

1903-1906 

89 

1901-1906 

90 

1905-1912 

91 

1903-1913 

92 

1899-1912 

93 

1899-1912 

94 

1876-1890 

1891-1900 

95 

1876-1900 

96 

1901-1913 

97 

1899-1912 

98 

1899-1912 

99 

1908-1912 

100 

1900-1912 

101 

1907-1912 

102 

1906-1912 

103 

1905-1912 

104 

1901-1913 

105 

1901-1912 

106 

1900-1907 

107 

1899-1912 

108 

1907-1912 

109 

1900-1912 

110 

1865-1897 

111 

1901-1913 

APPENDIX  D 

Australian  Companies 

Table         Period  Company  Title  Page 

113  1849-1888       Australian  Mutual  Provident Cancer,  by  Age  and  Sex 398 

114  1849-1888       Australian  Mutual  Provident Tumor,  by  Age  and  Sex 398 

East  Indian  Companies 

115  1897-1913       The  Oriental  Government  Se- 

curity Life  Assurance,  Bombay . . .  By  Race 399 

116  1911-1913       The  Dutch  East  Indian  Life 

Insurance,  Batavia By  Age 399 

Japanese  Companies 

117  1899-1907       Meiji  Life  Assurance BySex 399 

118  1899-1907       Meiji  Life  Assurance By  Age  and  Sex 400 

119  1899-1907       Meiji  Life  Assurance By  Organs  and  Parts,  accord- 

ing to  Sex 400 

120  1910-1912       Domestic  Companies. . By  Organs  and  Parts,  accord- 

ing to  Age  and  Sex 401 

121  1912  Foreign  Companies By  Organs  and  Parts,  accord- 

ing to  Age,  Males 401 


320 


APPENDIX  D 

Table  1 
Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — White 

Mortality  from  Cancer 

1891-1913 


Deaths 

from  All 

Year  Causes 

1891 17,420 

1892 20,439 

1893 22,190 

1894 26,527 

1895 29,720 

1891-1895 116,296 

1896 30,450 

1897 29,564 

1898 31,396 

1899 35,992 

1900 42,433 

1896-1900 169,835 

1901 46,076 

1902 47,870 

1903 51,896 

1904 58,211 

1905 57,665 

1901-1905 261,718 

1906 62,210 

1907 66,174 

1908 64,277 

1909 67,390 

1910 76,916 

1906-1910 336,967 

1911 78,216 

1912 80,165 

1913 86,806 


Deaths 

from 

Cancer 

515 
614 
750 

832 
943 


17,727 

4,324 
4,770 
5,285 


Cancer 
Per  Cent. 

3.0 
3.0 
3.4 
3.1 
3.2 


3,654 

3.1 

1.087 

3.6 

1,180 

4.0 

1,214 

3.9 

1,413 

3.9 

1,616 

3.8 

6,510 

3.8 

1,877 

4.1 

1,986 

4.1 

2,304 

4.4 

2,530 

4.8 

2,766 

4.8 

11,463 

4.4 

3,110 

5.0 

3,375 

5.1 

3,414 

5.3 

3,684 

5.5 

4,144 

5.4 

5.3 

5.5 
6.0 

6.1 


321 


APPENDIX  D 

Table  2 
Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — White 

Mortality  from  Cancer,  by  Sex 

1891-1913 


MALES 

FEMALES 

Deaths 

Deaths 

Deaths 

Deaths 

from  All 

from 

Caucer 

from  All 

from 

Cancer 

Year 

Causes 

Cancer 

Per  Cent. 

Causes 

Cancer 

Per  Cent. 

1891 

8,916 

173 

1.9 

8,504 

342 

4.0 

1892 

10,544 

203 

1.9 

9,895 

411 

4.2 

1893 

11,612 

237 

2.0 

10,578 

513 

4.8 

1894 

13,981 

294 

2.1 

12,546 

538 

4.3 

1895 

15,473 

319 

2.1 
2.0 

14,247 

624 

4.4 

1891-1895 

60,526 

1,226 

55,770 

2,428 

4.4 

1896 

15,565 

394 

2.5 

14,885 

693 

4.7 

1897 

14,913 

394 

2.6 

14,651 

786 

5.4 

1898 

15,868 

423 

2.7 

15,528 

791 

5.1 

1899 

17,981 

445 

2.5 

18,011 

968 

5.4 

1900 

21,267 

566 

2.7 
2.6 

21,166 
84,241 

1,050 

5.0 

1896-1900 

85,594 

2,222 

4,288 

5.1 

1901 

23,065 

609 

2.6 

23,011 

1,268 

5.5 

1902 

24,106 

611 

2.5 

23,764 

1,375 

5.8 

1903 

26,277 

757 

2.9 

25,619 

1,547 

6.0 

1904 

28,942 

825 

2.9 

29,269 

1,705 

5.8 

1905 

28,380 

910 

3.2 

2.8 

29,285 

1,856 

6.3 

1901-1905 

....       130,770 

3,712 

130,948 

7,751 

5.9 

1906 

31,242 

992 

3.2 

30,968 

2,118 

6.8 

1907 

33,591 

1,128 

3.4 

32,583 

■    2,247 

6.9 

1908 

31,803 

1,127 

3.5 

32,474 

2,287 

7.0 

1909 

34,038 

1,215 

3.6 

33,352 

2,469 

7.4 

1910 

38,499 

1,310 

3.4 
3.4 

38,417 

2,834 

7.4 

1906-1910 

....       169,173 

5,772 

167,794 

11,955 

7.1 

1911 

38,881 

1,414 

3.6 

39,335 

2,910 

7.4 

1912 

40,128 

1,516 

3.8 

40,037 

3.254 

8.1 

1913 

43,587 

1,7.57 

4.0 

43,219 

3,528 

8.2 

322 


APPENDIX  D 

Table  3 
Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — White 

Mortality  from  Cancer  and  from  All  Causes,  by  Age  and  Sex 

1909-1913 


Deaths 
from  All 

Ages  Causes 

Under  5 20,747 

5-9 9,922 

10-14 5,153 

15-19 7,659 

20-24 10,079 

25-29 10,523 

30-34 11,409 

35-39 12,338 

40-44 12,288 

45-49 12,629 

50-54 13,669 

55-59 14,678 

60-64 16,011 

65-69 15,177 

70-74 11,910 

75-79 7,443 

80  and  over 3,498 

Total 195,133 


7,212 


3.7 


MALES 

Deaths 

I 
Deaths 

"EMALES 
Deaths 

from 

Cancer 

from  All 

from 

Cancer 

Cancer 

Per  Cent. 

Causes 

Cancer 

Per  Cent. 

49 

0.2 

17,962 

37 

0.2 

49 

0.5 

8,376 

25 

0.3 

25 

0.5 

4,502 

23 

0.5 

44 

0.6 

7,004 

48 

0.7 

62 

0.6 

10,399 

76 

0.7 

75 

0.7 

10,964 

191 

1.7 

121 

1.1 

10,726 

450 

4.2 

206 

1.7 

10,855 

798 

7.4 

338 

2.8 

10,822 

1,354 

12.5 

578 

4.6 

11,367 

1,731 

15.2 

857 

6.3 

13,233 

2,203 

16.6 

1,103 

7.5 

14,709 

2,166 

14.7 

1,304 

8.1 

16,969 

2,090 

12.3 

1,141 

7.5 

17,165 

1,779 

10.4 

727 

6.1 

14,685 

1,195 

8.1 

409 

5.5 

9,552 

607 

6.4 

124 

3.5 

5,070 

222 

4.4 

194,360       14,995 


7.7 


Table  4 
Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — White 
Mortality  from  Sarcoma  and  from  Other  Forms  of  Cancer,  by  Age 

1909-1912 


Sarcoma 

Number 

of  Per 

Ages  Deaths  Cent. 

Under  5 29         4.7 

5-9 21         3.4 

10-19 48        7.8 

20-29 74  12.0 

30-39 72  11.7 

40-49 81  13.1 

50-59 128  20.7 

60-69 119  19.3 

70-79 42        6.8 

80  and  over 3        0.5 

Total 617  100.0 

Under  40 244  39.6 

40  and  over 373  60.4 


Other  Forms 
OF  Cancer 

Number 

of 
Deaths 

Per 

Cent. 

36 

0.2 

25 

0.2 

60 

0.4 

218 

1.3 

1,132 

6.9 

2,967 

18.2 

4,663 

28.6 

4,725 

29.0 

2,218 

13.6 

255 

1.6 

16,299 

100.0 

1,471 

9.0 

14,828 

91.0 

323 


APPENDIX  D 

Table  5 
Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — White 

Mortality  from  Sarcoma  and  from  Other  Forms  of  Cancer 

by  Age  and  Sex 

1909-1912 


MALES 

FEMALES 

Sarcoma 

Other  Forms 
OF  Cancer 

Sarcoma 

Other  Forms 
OF  Cancer 

Number 

Number 

Number 

Number 

of 

Per 

of             Per 

of 

Per 

of            Per 

Ages 

Deaths 

Cent. 

Deaths       Cent. 

Deaths 

Cent. 

Deaths      Cent. 

Under  5 

18 

6.1 

17         0.3 

11 

3.4 

19         0.2 

5-9 

14 

4.8 

15         0.3 

7 

2.2 

10         0.1 

10-19 

26 

8.8 

24         0.5 

22 

6.8 

36         0.3 

20-29 

43 

14.6 

55         1.1 

31 

9.6 

163         1.5 

30-39 

33 

11.2 

217         4.2 

39 

12.1 

915         8.2 

40-49 

34 

11.6 

670       13.0 

47 

14.6 

2,297       20.6 

50-59 

54 

18.4 

1,407       27.2 

74 

22.9 

3,256       29.2 

60-69 

54 

18.4 

1,815       35.2 

65 

20.1 

2,910      26.1 

70-79 

17 

5.8 

850       16.5 

25 

7.7 

1,368       12.3 

80  and  over 

1 

0.3 

91         1.7 

2 
323 

0.6 

164         1.5 

294 

Total 

100.0 

5,161     100.0 

100.0 

11,138     100.0 

Under  40 

134 

45.5 

328         6.4 

110 

34.1 

1,143       10.3 

40  and  over 

160 

54.5 

4,833       93.6 

213 

65.9 

9,995       89.7 

Table  6 
Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — White 

Mortality  from  Cancer  and  Average  Age  at  Death,  by  Organs  and 

Parts,  according  to  Sex 

1909-1913 


Organ  or  Part 

Buccal  cavity 

Stomach  and  liver 

Peritoneum,     intestines 
and  rectum 

Number 

of 
Deaths 

603 
3,628 

819 

36 

346 

1,470 

310 

7,212 

MALES 

Aggregate 
Years 
of  Life 

35,768 
213,200 

46,189 

2,026 
21,715 

79,827 
17,590 

Average 
Age  at 
Death 

59.3 

58.8 

56.4 

56.3 
62.8 
54.3 
56.7 

57.7 

Number 

of 
Deaths 

157 

5,022 

1,576 

4,180 

1,737 

261 

1,235 

827 

FEMALES 

Aggregate 
Years 
of  Life 

9,377 
293,488 

89,334 

215,.397 
94,966 

16,475 
64,896 
44,494 

Average 
Age  at 
Death 

59.7 

68.4 

66.7 

Female   generative   or- 
gans  

Breast 

Skin 

Other  organs 

Organs  not  specified .  . . 

51.5 
54.7 
63.1 
52.5 
53.8 

All  organs 

416,315 

14,995 

828,427 

55.2 

324 


APPENDIX  D 

Table  7 

Industrial  Mortality  Experience  of  Tlie  Prudential  Insurance  Company  of 

America — White 

Mortality  from  Sarcoma  and  Average  Age  at  Death,  by  Organs 

and  Parts,  according  to  Sex 

1909-1912 


MALES 

Number 
Organ  or  Part  of 

Deaths 

Buccal  cavity 18 

Stomach  and  liver 23 

Peritoneum,  intestines  and  rectum 20 

Breast 1 

Skin 10 

Other  organs 184 

Organs  not  specified 38 

All  organs 294 

FEMALES 

Buccal  cavity 20 

Stomach  and  liver 30 

Peritoneum,  intestines  and  rectum 24 

Female  generative  organs 23 

Breast 6 

Skin 12 

Other  organs 155 

Organs  not  specified 53 

All  organs 323 


Aggregate 

Average 

\ear3 

Age  at 

of  Life 

Death 

864 

48.0 

907 

39.4 

791 

39.6 

42 

42.0 

451 

45.1 

7,032 

38.2 

1,927 

50.7 

12.014 


40.9 


1,110 

55.5 

1,567 

52.2 

1,171 

48.8 

963 

41.9 

331 

55.2 

567 

47.3 

6,834 

44.1 

2,426 

45.8 

14,969 


46.3 


325 


APPENDIX  D 

Table  8 
Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — ^White 
Mortality  from  Cancer,  by  Single  Years  of  Life,  according  to  Sex 

1909-1913 


MALES 

FEMALES 

Age 

Number 

Aggregate 

Number 

Aggregate 

at 

of 

Years  of 

of 

Years  of 

Death 

Deaths 

Life 

Deaths 

Life 

2 

12 

24 

15 

30 

3 

21 

63 

11 

S3 

4 

16 

64 

11 

44 

5 

17 

85 

5 

25 

6 

12 

72 
70 

4 
3 

24 

7 

10 

21 

8 

9 

72 

8 

64 

9 

1 

9 

5 

45 

10 

9 

90 

4 

40 

11 

5 

55 

5 

65 

12 

4 

48 

1 

12 

13 

5 

65 

4 

52 

14 

2 

28 

9 

126 

15 

4 

60 

7 

105 

16 

7 

112 

7 

112 

17 

8 

136 

15 

255 

18 

14 

252 

8 

144 

19 

11 

209 

11 

209 

20 

12 

240 

9 

180 

21 

11 

231 

8 

168 

22 

18 

396 

15 

330 

23 

5 

115 

17 

391 

24 

16 

384 

27 

648 

25 

20 

500 

16 

400 

26..... 

17 

442 

32 

832 

27 

16 

432 

35 

945 

28 

11 

308 

56 

1,568 

29 

11 

319 

52 

1.508 

30 

17 

510 

63 

1,890 

31 

17 

527 

80 

2,480 

32 

29 

928 

94 

3,008 

33 

29 

957 

99 

3,267 

34 

29 

986 

114 

3,876 

35 

38 

1,330 

112 

3,920 

36 

37 

1,332 

138 

4,968 

37 

39 

1,443 

147 

5,439 

38 

47 

1,786 

200 

7.600 

39 

45 

1,755 

201 

7,839 

40 

47 

1,880 

243 

9,720 

41 

49 

2,009 

243 

9,963 

42 

83 

3,486 

278 

11,676 

43 

72 

3,096 

277 

11,911 

87 

3,828 

313 

13,772 

45 

107 

4,815 

311 

13,995 

46 

121 

5,566 

311 

14,306 

47 

110 

5,170 

355 

16,685 

Ill 

5,328 

377 

18,096 

49 

129 

6,321 

377 

18,473 

326 


APPENDIX  D 

Table  8  (concluded) 

Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — White 
Mortality  from  Cancer,  by  Single  Years  of  Life,  according  to  Sex 

1909-1913 


MALES 


Age  Number 

at  of 

Death  Deaths 

60 16-1 

51 167 

52 193 

53 164 

54 169 

55 207 

56 206 

57 219 

58 225 

59 246 

60 235 

61 268 

62 251 

63 284 

64 266 

65 269 

66 245 

67 209 

68 207 

69 211 

70 205 

71 154 

72. 124 

73 142 

74 102 

75 125 

76 88 

77 85 

78 64 

79 ; 47 

80 34 

81 34 

82 16 

83 14 

84 9 

85 5 

86 5 

87 3 

88 1 

89 

90 1 

91 

92 

93 2 

Total 7,212 

Average  age 


Aggregate 
Years  of 

Life 

8,200 

8,517 

10,036 

8,692 

9,126 

11,385 

11,536 

12,483 

13,050 

14,514 

14,100 

16,348 

15,562 

17,892 

17,024 

17,485 

16,170 

14,003 

14,076 

14,559 

14,350 

10,934 

8,928 

10,366 

7,548 

9,375 

6,688 

6,545 

4,992 

3,713 

2,720 

2,754 

1,312 

1,162 

756 

425 

430 

261 


90 


186 


416,315 

57.7 


FEMALES 

STumber 

Aggregate 

of 

Years  of 

Deaths 

Life 

428 

21,400 

459 

23,409 

449 

23,348 

443 

23,479 

424 

22,896 

423 

23,265 

457 

25,592 

414 

23,598 

410 

23,780 

462 

27,258 

423 

25,380 

404 

24,644 

421 

26,102 

406 

25,578 

436 

27,904 

382 

24,830 

393 

25,938 

356 

23,852 

313 

21,284 

335 

23,115 

298 

20,860 

263 

18,673 

240 

17,280 

205 

14,965 

189 

13,986 

168 

12,600 

131 

9,956 

118 

9,086 

106 

8,268 

84 

6,636 

62 

4,960 

46 

3,726 

38 

3,116 

28 

2,324 

18 

1,512 

16 

1,360 

6 

616 

6 

522 

*i 

89 

1 

90 

14,995 


828,427 
55.2 


327 


APPENDIX  D 

Table  9 
Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — Wliite 

Mortality  from  Cancer  of  the  Buccal  Cavity,  by  Single  Years  of  Life 

according  to  Sex 

1909-1913 


MALES 

FEMALES 

Age 

Number 

Aggregate 

Number 

Aggregate 

at 

of 

Years  of 

of 

Years  of 

Death 

Deaths 

Life 

Deaths 

Life 

2 

1 

2 

3 

4 

1 

4 

2 

8 

5 

6 

2 

12 

7 

8 

9 

10 

i 

io 

11 

12 

i 

ii 

12 

...  .  ......       1 

13 

14 

15 

i 

is 

16 

1 

16 

17 

i 

17 

18 

2 

36 

19 

1 

19 

20 

1 

20 

21 

1 

21 

1 

2i 

22 

1 

22 

23 

1 

23 

24 

1 

24 

25 

26 

27 

28 

29 

i 

29 

30 

31 

1 

si 

2 

62 

32 

1 

32 

1 

32 

33 

34 

1 

34 

i 

34 

35 

3 

105 

1 

35 

36 

3 

108 

1 

36 

37 

38 

1 

38 
156 

i 

39 

4 

39 

40 

2 

80 

1 

40 

41 

6 

246 

2 

82 

42 

6 

252 

3 

126 

43     ... 

7 

301 
308 

1 

1 

43 

44 

7 

44 

45 

5 

225 

1 

45 

46 

9 

414 

1 

46 

47 

7 

329 

1 

47 

48 

16 

768 

2 

96 

328 


APPENDIX  D 

Table  9  (concluded) 
Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — White 

Mortality  from  Cancer  of  the  Buccal  Cavity,  by  Single  Years  of  Life 

according  to  Sex 

1909-1913 


MALES 

FEMALES 

Age 

Number 

Aggregate 

Number                Aggregate 

at 

of 

Years  of 

of                       Years  of 

Death 

Deaths 

Life 

Deaths                      Life 

49 

17 

833 

2                          98 

50 

18 

900 

4                    200 

51 

13 

663 

2                    102 

52 

15 

780 

3                    156 

53 .1.... 

13 

689 

6                   318 

54 

16 

864 

2                   108 

55 

18 

990 

2                   110 

56 

19 

1,064 

6                   336 

57 

22 

1,254 

4                   228 

58 

18 

1,044 

7                   406 

59 

27 

1,593 

3                   177 

60 

18 

1,080 

1                     60 

61 

18 

1,098 

3                   183 

62 

16 

992 

5                   310 

63 

25 

1,575 

3                   189 

64 

21 

1,344 

5                   320 

65 

22 

1.430 

5                   325 

66 

17 

1,122 

10                   660 

67 

19 

1,273 

5                   335 

68 

20 

1,360 

1                     68 

69 

19 

1,311 
1,120 

4                   276 

70 

16 

5                   350 

71 

11 

781 

3                   213 

72 

11 

792 

3                   216 

73 

16 

1,168 

3                   219 

74 

12 

888 

6                   444 

75 

13 

975 

6                   450 

76 

10 

760 

5                    380 

77 

5 

385 

1                     77 

78 

5 

390 

5                    390 

79 

3 

237 

2                    158 

80 

2 

160 

1                     80 

81 

6 

486 

2                   162 

82 

5 

410 

83 

1 

83 

2                   166 

84 

1                     84 

85 

.  ; 2 

170 

1                     85 

86 

1 

86 

.. 

Total 

603 

35,768 

157                9,377 

Average  age 

59.3 

59.7 

329 


APPENDIX  D 

Table  10 
Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — White 
Mortality  from  Cancer  of  the  Stomach  and  Liver,  by  Single  Years  of  Life 

according  to  Sex 
1909-1913 


MALES 

FEMALES 

Age 

Number 

Aggregate 

Number 

Aggregate 

at 

of 

Years  of 

of 

Years  of 

Death 

Deaths 

Life 

Deaths 

Life 

2 

2 

4 

3 

6 

3 

3 

9 

1 

3 

4 

3 

12 

5 

3 

15 

1 

5 

6 

2 

12 

1 

6 

7 

4 

28 

1 

7 

8 

2 

16 

1 

8 

9 

2 

18 

10 

1 

10 

11 

1 

11 

1 

11 

12 

13 

14 

1 

14 

15... 

1 

15 

16 

1 

16 

1 

16 

17 

1 

17 

18 

2 

36 

,   , 

19 

2 

38 

20 

1 

20 

4 

80 

21 

3 

63 

22 

2 

44 

i 

22 

23 

1 

23 

3 

69 

24 

8 

192 

4 

96 

25 

4 

100 

2 

50 

26 

4 

104 

5 

130 

27 

4 

108 

7 

189 

28 

5 

140 

7 

196 

29 

2 

58 

7 

203 

30 

3 

90 

7 

210 

31 

8 

248 

17 

527 

32 

7 

224 

15 

480 

33 

11 

363 

21 

693 

34 

15 

510 

21 

714 

35 

15 

525 

22 

770 

36 

18 

648 

20 

720 

37 

19 

703 

21 

777 

38 

24 

912 

43 

1,634 

39 

23 

897 

43 

1,677 

40 

21 

840 

56 

2,240 

41 

25 

1,025 

47 

1,927 

42 

42 

1,764 

67 

2,814 

43 

35 

1,505 

55 

2,365 

44 

51 

2,244 

63 

2,772 

45 

55 

2,475 

78 

3,510 

46 

62 

2,852 

75 

3,450 

47 

57 

2,679 

97 

4,559 

48 

57 

2,736 

108 

5,184 

330 


APPKXDIX  D 

Table  10  (concluded) 
Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — White 
Mortality  from  Cancer  of  the  Stomach  and  Liver,  by  Single  Years  of  Life 

according  to  Sex 
1909-1913 


MALES 

FEMALES 

Age 

Number 

Aggregate 

Number 

Aggregate 

at 

of 

Years  of 

of 

\  ears  of 

Death 

Deaths 

Life 

Deaths 

Life 

49 

56 

2,744 

110 

5,390 

50 

79 

3,950 

109 

5,450 

51 

94 

4,794 

136 

6,936 

52 

115 

5,980 

158 

8,216 

53 

89 

4,717 

127 

6,731 

54 

88 

4,752 

148 

7,992 

55 

113 

6,215 

145 

7,975 

56 

Ill 

6,216 

165 

9,240 

57 

Ill 

6,327 

166 

9,462 

58 

118 

6,844 

156 

9,048 

59 

146 

8,614 

201 

11,859 

60 

120 

7,200 

176 

10,560 

61 

165 

10,065 

177 

10,797 

62 

151 

9,362 

183 

11,346 

63 

153 

9,639 

158 

9,954 

64 

145 

9,280 

188 

12,032 

65 

144 

9,360 

164 

10,660 

66 

132 

8,712 

171 

11,286 

67 

107 

7,169 

136 

9,112 

68 

101 

6,868 

130 

8,840 

69 

100 

6,900 

134 

9,246 

70 

99 

6,930 

119 

8,330 

71 

78 

5,538 

111 

7,881 

72 

65 

4,680 

109 

7,848 

73 

52 

3,796 

99 

7,227 

74 

51 

3,774 

82 

6,068 

75 

60 

4,500 

79 

5,925 

76 

37 

2,812 

52 

3,952 

77 

43 

3,311 

46 

3,542 

78 

33 

2,574 

29 

2,262 

79 

26 

2,054 

41 

3,239 

80 

17 

1,360 

36 

2,880 

81 

7 

567 

14 

1,134 

82 

5 

410 
249 

11 
8 

902 

83 

3 

664 

84 

6 

504 

6 

504 

85 

4 

340 

86 

2 

172 

1 

86 

87 

3 

261 

88 

i 

89 

89 

Total 

3,628 

213,200 

5,022 

293,488 

Average  age 

58.8 

58.4 

331 


APPENDIX  D 

Table  11 
Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — White 

Mortality  from  Cancer  of  the  Peritoneum,  Intestines  and  Rectum 

by  Single  Years  of  Life,  according  to  Sex 

1909-1913 


MALES 

FEMALES 

Age 

Number 

Aggregate 

Number 

Aggregate 

at 

of 

Years  of 

of 

Years  of 

Death 

Deaths 

Life 

Deaths 

Life 

2 

3 

3 

9 

4 

20 

6 

7 
16 

4 

1 

5 

4 

6 

1 

6 

7 

1 

8 

2 

16 

9 

9 

10 

11 

12 

i 

12 

13 

14 

28 

15 

15 

16 

, , 

17 

1 

17 
38 

18 

19 

2 

19 

2 

40 
21 

21 

1 

21 

22 

3 

66 

3 

66 

23 

, , 

24 

6 

144 

25 

3 

75 

3 

75 

26 

5 

130 

4 

104 

27 

4 

108 

3 

81 

28 

3 

84 

6 

168 

29 

2 

58 
240 

6 

8 

174 

30 

8 

240 

31 

5 

155 

4 

124 

32 

8 

256 

12 

384 

33 

5 

165 

11 

363 

34 

3 

102 

14 

476 

35 

6 

210 
180 

11 
10 

385 

36 

5 

360 

37 

8 

296 

14 

518 

38 

4 

152 

13 

494 

39 

3 

117 

19 

741 

8 

320 

287 

23 
25 

920 

41 

7 

1,025 

42 

11 

462 

19 

798 

43 

9 

387 

19 

817 

44 

3 

132 

34 

1,496 

45 

9 

405 

22 

990 

46 

19 

874 

33 

1,518 

47 

17 

799 

30 

1,410 

48 

8 

384 

34 

1,632 

49 

20 

980 

42 

2,058 

50 

23 

1,150 

34 

1,700 

332 


APPENDIX  D 

Table  11  (concluded) 
Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — Whi  te 

Mortality  from  Cancer  of  the  Peritoneum,  Intestines  and  Rectum 

by  Single  Years  of  Life,  according  to  Sex 

1909-1913 


Age 

at 

Death 

51..., 
52..., 
53.... 
54.... 
55.... 
56.... 
57.... 
58.... 
59.... 
60.... 
61.... 
62.... 
63.... 
64.... 

65 

66.... 
67. . . . 
68. . . . 
69.... 
70. . . . 
71.... 
72. . . . 
73. . . . 
74.... 
75.... 
76. . . . 
77. . . . 
78. . . . 
79. . . . 
80. . . . 
81.... 
82. . . . 
83.... 
84.... 
85.... 
86.... 
87. . . . 
88. . . . 
89. . . . 
90.,.. 
91.... 
9«.... 
93. . . . 
94.... 
95. . . . 


MALES 

Number 

Aggregate 

of 

Years  of 

Deaths 

Life 

18 

918 

20 

1,040 

24 

1,272 

21 

1,134 

23 

1,265 

25 

1,400 

23 

1,311 

29 

1,682 

18 

1,062 

27 

1,620 

18 

1,098 

26 

1,612 

32 

2,016 

36 

2,304 

24 

1,560 

30 

1,980 

14 

938 

21 

1,428 

28 

1,932 

29 

2,030 

18 

1,278 

18 

1,296 

16 

1,168 

9 

666 

11 

825 

10 

760 

8 

616 

5 

390 

3 

237 

1 

80 

2 

162 

166 


86 


93 


Total... 
Average  age. 


819 


46,189 
56.4 


FEMALES 

Number 

Aggregate 

of 

Years  of 

Deaths 

Life 

41 

2,091 

39 

2,028 

58 

3,074 

43 

2,322 

47 

2,585 

47 

2,632 

29 

1,653 

41 

2,378 

46 

2,714 

45 

2,700 

43 

2,623 

47 

2,914 

54 

3,402 

56 

3,584 

46 

2,990 

53 

3,498 

45 

3,015 

25 

1,700 

44 

3,036 

39 

2,730 

42 

2,982 

30 

2,160 

20 

1,460 

23 

1,702 

21 

1,575 

17 

1,292 

10 

770 

17 

1,326 

9 

711 

5 

400 

5 

405 

6 

492 

4 

332 

3 

252 

3 

255 

90 


1,576 


89,334 
56.7 


333 


APPENDIX  D 

Table  12 
Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — White 

Mortality  from  Cancer  of  the  Female  Generative  Organs 

by  Single  Years  of  Life 

1909-1913 


Age 

Number 

Aggregate 

Age 

Number 

Aggregate 

at 

of 

Years  of 

at 

of 

Years  of 

Death 

Deaths 

Life 

Death 

Deaths 

Life 

2 ... 

2 

4 

47 

...      121 

5,687 

3 

48 

...      125 

6,000 

4 

49 

...      122 

5,978 

5 

50 

...     174 

8,700 

6 

51 

52 

...      156 
...      141 

7,956 

7 

7,332 

8 

8 

io 

53 

54 

55 

...     136 
...      140 
...      127 

7,208 

9 

7,560 

10 

6,985 

11 

56. 

...      128 

7,056 

12 

57 

...      115 

6,555 

13 

13 

58 

...      104 

6,032 

14 

59 

...      Ill 

6,549 

15 .. 

2 

30 

60 

95 

5,700 

16 

16 

61 

...       81 

4,941 

17 

3 

51 

62 

...       96 

5,952 

18 

2 

36 

63 

93 

5,859 

19 

1 

19 

64 

...       81 

5,184 

20 

1 

20 

65 

...       75 

4,875 

21 

2 

42 

66 

...       58 

3,828 

22 

3 

66 

67 

75 

5,025 

23 

5 

115 

68 

...       67 

4,556 

24 

9 

216 

69 

...        69 

4,761 

5 

125 

70 

...       51 

3,570 

26 

16 

416 

71 

39 

2,769 

27 

15 

405 

72 

...       34 

2,448 

28 

24 

672 

73 

...       25 

1,825 

29 

18 

522 

74 

25 

1,850 

30 

26 

780 

75 

16 

1,200 

31 

34 

1,054 

76 

20 

1,520 

32 

47 

1,504 

77 

17 

1,309 

33 

40 

1,320 

78 

16 

1,248 

34 

46 

1,564 

79 

5 

395 

35 

51 

1,785 

80 

1 

80 

36 

65 

2,340 

81 

6 

486 

37 

74 

2,738 

82 

6 

492 

38 

81 

3,078 
2,652 

83 

84 

6 

498 

39 

68 

40 

90 

3,600 

85 

41 

93 

3,813 

86 

i 

86 

42 

43 

115 

113 

4.830 
4,859 

87 

1 

87 

44 

125 

5,500 

Total 

. .  .  4,180 

215,397 

45 

126 

5,670 

46 

117 

5,382 

Average  age. .  . 

51.5 

334 


APPENDIX  D 

Table  13 

Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — White 

Mortality  from  Cancer  of  the  Breast,  by  Single  Years  of  Life 

according  to  Sex 

1909-1913 


MALES 

FEMALES 

Age 

at 

Death 

Number 

of 
Deaths 

Aggregate 

Years  of 

Life 

Number               Aggregate 

of                      Years  of 
Deaths                    Life 

2 

1                         2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

2                     44 

23 

24 

24 

i                     24 

25 

2                     50 

26 

27 

3                     81 

28 

3                     84 

29 

4                    116 

30 

11                    330 

31 

9                   279 

32 

8                   256 

33 

] 

13                   429 

34 

] 

LO                   340 

35 

12                   420 

36 

23                   828 

37 

1 

37 

17                   629 

38 

34                 1,292 

39 

1 

39 

! 

34                1,326 

40 

32                1,280 

41 

44                1,804 

42 

1 

42 

31                 1,302 

43 

1 

43 

48                2,064 

44 

1 

44 

12                1,848 

45 

4 

180 

tl                 1,845 

46 ». 

34                1,564 

47 

1 

47 

52                 2,444 

48 

31                 2,448 

335 


APPENDIX  D 

Table  13  (concluded) 
Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — White 

Mortality  from  Cancer  of  the  Breast,  by  Single  Years  of  Life 

according  to  Sex 

1909-1913 


MALES 

FEMALES 

Age 

Nvunber 

Aggregate 

Number              Aggregate 

at 

of 

Years  of 

of                     Years  of 

Death 

Deaths 

Life 

Deaths                    Life 

49 

51                 2,499 

50 

1 

50 

50                2,500 

51 

1 

51 

67                3,417 

52 

1 

52 

57                2,964 

53 

56                2,968 

54 

45                 2,430 

55 

3 

165 

43                2,365 

56 

1 

56 

54                3,024 

57 

1 

57 

45                2,565 

58 

2 

116 

46                2,668 

59 

41                 2,419 

60 

1 

60 

42                2,520 

61 

53                3,233 

62 

1 

62 

42                2,604 

63 

36                2,268 

64 

1 

64 

41                 2,624 

65 

2 

130 

39                2,535 

66 

40                2,640 

67 

3 

201 

38                2,546 

207 

36                2,448 

69 

3 

30                2,070 

2 

140 

36                2,520 

71 

31                 2,201 

72 

26                1,872 

73 

1 

73 

23                1,679 

74 

23                1,702 

75 

17                1,275 

16                1,216 

77 

9                   693 

78 

5                   390 

79 

14                 1,106 

80 

8                   640 

81 

5                   405 

82 

4                   328 

83 

3                   249 

84 

2                   168 

85 

86 

1 

36 

86 

i                     86 

Total 

2,026 

1,737              94,966 

56.3 

54.7 

336 


APPENDIX  D 


Table  14 
Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — White 

Mortality  from  Cancer  of  the  Skin,  by  Single  Years  of  Life 

according  to  Sex 

1909-1913 


MALES 

FEMALES 

Age                                                                 Number              Agg 

regate                    Number 

Aggregate 

at 

of                   Ye 

irs  of                            of 

Years  of 

Death                                                                Deaths                    I 

ife                         Deaths 

Life 

2 

,  , 

3 

i 

3                    i 

3 

4 

1 

4 

5 

2 

10 

6 

7 

, , 

8 

9 

10 

11 

12 

i 

12 

13 

1 

13 

14 

1 

14 

15 

16 

. . 

17 

, . 

18 

19 ,. 

20 

21 

21 

22 

23 

24 

25 

1                <, 

15 

26 

26 

27 

28 

2 

56 

29 

1               j 

i9                            1 

29 

30 

31 

32 

2                     ( 

34                            1 

32 

33 

2                     ( 

56 

34 

34 

35 

36 

i                    i 

56                              i 

36 

37 

37 

38 

1                    i 

2 

}8 

r8 

39 

40 

2                      i 

50                            2 

80 

41 

1                      i 

H                            3 

123 

42 

5                    2] 

LO                              2 

84 

43 

2                      i 

56                            4 

172 

44 

2                      { 

58                            1 

44 

45 

5                    25 

15                            5 

225 

46 

7                    3$ 

1% 

47 

3                    1^ 

H                            3 

141 

48 

4                    U 

m                       3 

144 

337 


APPENDIX  D 

Table  14  (concluded) 
Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — White 

Mortality  from  Cancer  of  the  Skin,  by  Single  Years  of  Life 

according  to  Sex 

1909-1913 


MALES 

FEMALES 

Age 

Number 

Aggregate 

Number 

Aggregate 

at 

of 

Years  of 

of 

Years  of 

Death 

Deaths 

Life 

Deaths 

Life 

49 

6 

294 

5 

245 

50 

3 

150 

3 

150 

51 

4 

204 

4 

204 

52 

5 

260 

2 

104 

53 

5 

265 

4 

212 

54 

10 

540 

1 

54 

55 

7 

385 

7 

385 

5Q 

6 

336 

6 

336 

57 

11 

627 

5 

285 

58 

5 

290 

4 

^       232 

59 

11 

649 

3 

177 

GO 

14 

840 

5 

300 

61 

16 

976 

8 

488 

62 

11 

682 

10 

620 

63 

11 

693 

8 

604 

64 

9 

576 

10 

640 

65 

14 

910 

3 

195 

66 

16 

1,056 

8 

528 

67 

11 

737 

6 

402 

68 

11 

748 

12 

816 

69 

11 

759 

8 

552 

70 

10 

700 

11 

770 

71 

.....'...           8 

568 

6 

426 

72 

11 

792 
876 

10 

7 

720 

73 

12 

511 

74 

9 

666 

8 

592 

75 

9 

675 
760 

5 
5 

375 

76 

10 

380 

77 

6 

462 

10 

770 

78 

2 

156 

6 

468 

79 

6 

474 

8 

632 

80 

8 

640 

4 

320 

81 

8 

648 

6 

486 

82 

2 

164 
83 

4 
1 

328 

83 

1 

83 

84 

3 

252 

85 

1 

85 

6 

510 

86 

87 

3 

346 

261 

1 

261 

87 

Total 

21,715 

16,475 

Average  Age 

62.8 

63.1 

338 


APPENDIX  J) 

Table  15 
Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — White 

Mortality  from  Cancer  of  Other  or  Not  Specified  Organs 

by  Single  Years  of  Life,  according  to  Sex 

1909-1913 


MALES 

FEMALES 

Age 

Number 

Aggregate 

Number 

Aggregate 

at 

of 

Years  of 

of 

Years  of 

Death 

Deaths 

Life 

Deaths 

Life 

2 

9 

18 

42 

9 
9 

18 

3 

14 

27 

4 

10 

40 

9 

36 

5 

10 

50 

2 

10 

6 

7 

42 
35 

2 

2 

12 

7 

5 

14 

8 

5 

40 
9 

4 

2 

32 

9 

1 

18 

10 

7 

70 

3 

30 

11 

4 

44 

3 

33 

12 

2 

24 

13 

5 

65 

2 

26 

14 

2 

28 

5 

70 

15 

3 

45 

3 

45 

16 

5 

80 

5 

80 

17 

7 

119 

10 

170 

18 

10 

180 

6 

108 

19 

8 

152 

7 

133 

20 

8 

160 
126 

4 
3 

80 

21 

6 

63 

22 

13 

286 

5 

110 

23 

4 

92 
144 

8 
7 

184 

24 

6 

168 

25 

12 

300 

4 

100 

26 

8 

208 

6 

156 

27 

8 

216 

7 

189 

28 

3 

84 
174 
180 

14 
15 
11 

392 

29 

6 

435 

30 

6 

330 

31 

Ci 

93 

14 

434 

32 

11 

352 

10 

320 

33 

11 

363 

14 

462 

34 

10 

340 

21 

714 

35 

14 

490 

15 

525 

36 

10 

360 

18 

648 

37 

11 

407 

20 

740 

38 

17 

646 

29 

1,102 

39 

12 

468 

36 

1,404 

40 

14 

560 

39 

1,560 

41 

10 

410 

29 

1,189 

42 

18 

756 

41 

1,722 

43 

18 

774 

37 

1,591 

44 

23 

1,012 

47 

2,068 

45 

29 

1,305 

38 

1,710 

46 

24 

1,104 

51 

2,346 

47 

25 

1,175 

51 

2,397 

48 

26 

1,248 

54 

2,592 

49 

30 

1,470 

45 

2,205 

339 


APPENDIX  D 

Table  15  (concluded) 
Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — White 

Mortality  from  Cancer  of  Other  or  Not  Specijfied  Organs 

by  Single  Years  of  Life,  according  to  Sex 

1909-1913 


IVIALES 


Age  Number 

at  of 

Death  Deaths 

50 40 

51 37 

52 37 

53 33 

54 34 

55 43 

56 44 

57 51 

58 53 

59 44 

60 55 

61 51 

62 46 

63 63 

64 54 

65 63 

66 50 

67 55 

68 54 

69 50 

70 49 

71 39 

72 19 

73 45 

74 21 

75 32 

76 21 

77 23 

78 19 

79 9 

80 6 

81 11 

82 4 

83 7 

84 3 

85 2 

86 

87 

88 1 

89 

90 1 

91 

92 

93 1 

Total 1,780 

Average  age 


Aggregate 

Years  of 

Life 

2,000 
1,887 
1,924 
1,749 
1,836 
2,365 
2,464 
2,907 
3,074 
2,596 
3,300 
3,111 
2,852 
3,969 
3,456 
4,095 
3,300 
3,685 
3,672 
3,450 
3,430 
2,769 
1,368 
3,285 
1,554 
2,400 
1,596 
1,771 
1,482 
711 
480 
891 
328 
581 
252 
170 


90 

93 

97,417 

54.7 


FEMALES 

S^umber 

Aggregate 

of 

Years  of 

Deaths 

.Life 

54 

2,700 

53 

2,703 

49 

2,548 

56 

2,968 

45 

2,430 

52 

2,860 

53 

2,968 

50 

2,850 

52 

3,016 

57 

3,363 

59 

3,540 

39 

2,379 

38 

2,356 

54 

3,402 

55 

3,520 

50 

3,250 

53 

3,498 

51 

3,417 

42 

2,856 

46 

3,174 

37 

2,590 

31 

2,201 

28 

2,016 

28 

2,044 

22 

1,628 

24 

1,800 

16 

1.216 

25 

1,925 

28 

2,184 

5 

395 

7 

560 

8 

648 

7 

574 

4 

332 

3 

252 

2 

170 

2 

172 

1 

87 

2,062 


109,390 
53.1 


340 


APPENDIX  D 

Table  16 

Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — White 

Mortality  from  Cancer,  by  Organs  and  Parts,  according  to  Sex 

at  Divisional  Periods  of  Life 

1909-1913 


MALES 
AGES  UNDER  35 

No.  of  Per 

Organ  or  Part                          Deaths  Cent. 

Buccal  cavity 17  4.0 

Stomach  and  liver 102  £4.0 

Peritoneum,  intestines,  rectum ...        68  16.0 

Female  generative  organs 

Breast 1  0.2 

Skin 8  1.9 

Other  or  not  specified  organs.  .  .  .      229  53.9 

All  organs 425  100.0 

AGES  35-44 

Buccal  cavity 39  7.2 

Stomach  and  liver 273  50.2 

Peritoneum,  intestines,  rectum.  . .        64  11.8 

Female  generative  organs 

Breast 5  0.9 

Skin 16  2.9 

Other  or  not  specified  organs 147  27.0 

All  organs 544  100.0 

AGES  45-64 

Buccal  cavity 331  8.6 

Stomach  and  liver 2,085  54.3 

Peritoneum,  intestines,  rectum. . .      436  11.3 

Female  generative  organs 

Breast 18  0.5 

Skin 153  4.0 

Other  or  not  specified  organs.  .  . .      819  21.3 

All  organs 3,842  100.0 


FEMALES 

No  of 

Per 

Deaths 

Cent. 

12 

1.4 

138 

16.2 

89 

10.5 

305 

35.9 

67 

7.9 

13 

1.5 

226 

26.6 

850 

100.0 

11 

0.5 

437 

20.3 

187 

8.7 

875 

40.7 

317 

14.7 

14 

0.6 

311 

14.5 

2.152 

100.0 

63 

0.8 

2,861 

34.9 

831 

10.1 

2,387 

29.1 

947 

11.6 

96 

1.2 

1,005 

12.3 

8,190 


100.0 


341 


APPENDIX  D 

Table  16  (concluded) 
Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — White 

Mortality  from  Cancer,  by  Organs  and  Parts,  according  to  Sex 

at  Divisional  Periods  of  Life 

1909-1913 


MALES 

AGES  65  AND  OVER 

No.  of  Per 

Organ  or  Part                          Deaths  Cent. 

Buccal  cavity 216  9.0 

Stomach  and  liver 1,188  48.6 

Peritoneum,  intestines,  rectum. . .      251  10.5 

Female  generative  organs 

Breast 12  0.5 

Skin 169  7.0 

Other  or  not  specified  organs.  .  . .      585  24.4 

All  organs 2,401  100.0 

ALL  AGES 

Buccal  cavity 603  8.4 

Stomach  and  liver 3,628  50.3 

Peritoneum,  intestines,  rectum. . .      819  11.3 

Female  generative  organs 

Breast 36  0.5 

Skin 346  4.8 

Other  or  not  specified  organs.  .  . .   1,780  24.7 

All  organs 7,212  100.0 


FEMALES 


No.  of 
Deaths 

71 
1,586 
469 
613 
406 
138 
520 


Per 

Cent. 

1.9 
41.7 
12.3 
16.1 
10.7 

3.6 
13.7 


3,803 

100.0 

157 

1.0 

5,022 

33.5 

1,576 

10.5 

4,180 

27.9 

1,737 

11.6 

261 

1.7 

2,062 

13.8 

14,995 


100.0 


APPENDIX  D 

Table  17 
Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — White 
Mortality  from  Cancer  at  Divisional  Periods  of  Life,  by  Organs  and  Parts 

according  to  Sex 
1909-1913 


Ages 

Under  35... 

35-44 

45-64 

65  and  over. 

Total. . . 


MALES 

BUCCAL 

CAVITY 

No.  of 
Deaths 

Per 

Cent. 

17 

2.8 

39 

6.5 

331 

54.9 

216 

35.8 

.       603  "  100.0 

STOMACH  AND  LIVER 


FEMALES 

No.  of 
Deaths 

Per 

Cent. 

12 
11 
63 
71 

7.7 

7.0 

40.1 

45.2 

Under  35 102 

35-44 273 

45-64 2,085 

65  and  over 1,168 


7.5 
57.5 


Total. 


Under  35... 

35-44 

45-64 

65  and  over . 

Total. . . 


Under  35... 

35-44 

45-64 

65  and  over. 

Total... 


Under  35... 

35-44 , 

45-64 

65  and  over. 

Total... 


Total 3,628  100.0 

PERITONEUM,  INTESTINES  AND  RECTUM 

Under  35 

35-44 

45-64 

65  and  over 


157 


138 

437 

2,861 

1,586 

5,022 


819  100.0 

FEMALE  GENERATIVE  ORGANS 


36 


100.0 


SKIN 


346 


100.0 


1,576 


1,737 


100.0 


2.7 

8.7 

57.0 

31.6 

100.0 


68 

8.3 

89 

5.6 

64 

7.8 

187 

11.9 

436 

53.2 

831 

52.7 

251 

30.7 

469 

29.8 

100.0 


305 

7.3 

875 

20.9 

2,387 

57.1 

613 

14.7 

4,180 

100.0 

BREAST 

1                      2.8 

67 

3.9 

5                   13.9 

317 

18.2 

18                   50.0 

947 

54.5 

12                   33.3 

406 

23.4 

100.0 


8 

2.3 

13 

5.0 

16 

4.6 

14 

5.3 

153 

44.2 

96 

36.8 

169 

48.9 

138 

52.9 

261 


100.0 


343 


APPENDIX  D 

Table  17  (concluded) 
Industrial  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — White 
Mortality  from  Cancer  at  Divisional  Periods  of  Life,  by  Organs  and  Parts 

according  to  Sex 
1909-1913 


MALES 
OTHER  OR  NOT  SPECIFIED  ORGANS 


Under  35... 

35-44 

45-64 

65  and  over . 

Total... 


No.  of 
Deaths 

229 
147 
819 

585 


Per 
Cent. 

12.9 

8.2 

46.0 

32.9 


. .   1,780  100.0 

ALL  ORGANS  AND  PARTS 


Under  35 425 

35-44 544 

45-64 3,842 

65  and  over 2,401 


Total 7,212 


5.9 

7.5 

53.3 

33.3 

100.0 


FEMALES 

No.  of 
Deaths 

Per 

Cent. 

226 

311 

1,005 

520 

11.0 
15.1 

48.7 
25.2 

2.062 

100.0 

850 
2,152 
8,190 
3,803 

5.7 
14.3 
54.6 

25.4 

14,995 


100.0 


Table  18 
Ordinary  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America 

Mortality  from  Cancer 

1891-1913 


Deaths 

Deaths 

Deaths 

Deaths 

from  All 

from 

Cancer 

from  All 

from 

Cancer 

Year 

Causes 

Cancer 

Per  Cent. 

Year 

Causes 

Cancer 

Per  Cent. 

1891 

33 

1901 

960 

38 

4.0 

1892 

46 

3 

6.5 

1902 

.     1,234 

61 

4.9 

1893 

73 

3 

4.1 

1903 

.     1,629 

84 

5.2 

1894 

76 

2 

2.6 

1904 

.     2,152 

85 

3.9 

1895 

149 

5 

13 

3.4 
3.4 

1905 

1901-1905 .  . 

.     2,181 

107 

4.9 

1891-1895 . . 

377 

.     8,156 

375 

4.6 

1896 

188 

7 

3.7 

1906 

.     2,584 

142 

5.5 

1897 

247 

14 

5.7 

1907 

.     2,943 

168 

5.7 

1898 

406 

13 

3.2 

1908 

.     3,231 

206 

6.4 

1899 

520 

12 

2.3 

1909 

.     3,466 

232 

6.7 

1900 

663 
.     2,024 

21 
67 

3.2 
3.3 

1910 

1906-1910. . 

.     3,946 

252 

6.4 

1896-1900.. 

.   16,170 

1,000 

6.2 

1911 

.     4.413 

263 

6.0 

1912 

.     4,696 

324 

6.9 

1913 

.     5,058 

387 

7.7 

344 


APPENDIX  D 

Table  19 
Ordinary  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America — White 

Mortality  from  Cancer,  by  Sex 

1891-1913 


MALES 

FEMALES 

Year 

Deaths 

from  All 

Causes 

Deaths 
from 
Cancer 

Cancer 
Per  Cent. 

Deaths 
from  All 
Causes 

Deaths 

from 
Cancer 

Cancer 
Per  Cent. 

1891 

28 

5 

1892 

39 

i 

2.6 

7 

2 

28.6 

1893 

64 

3 

4.7 

9 

1894 

69 

2 

2.9 

7 

1895 

138 

3 
9 

2.2 
2.7 

11 

2 
4 

18.2 

1891-1895 

338 

39 

10.3 

1896 

172 

6 

3.5 

16 

1 

6.3 

1897 

225 

11 

4.9 

22 

3 

13.6 

1898 

366 

10 

2.7 

40 

3 

7.5 

1899 

450 

9 

2.0 

70 

3 

4.3 

1900 

558 

16 

2.9 

105 

5 

4.8 

1896-1900 

1,771 

52 

2.9 

253 

15 

5.9 

1901 

810 

29 

3.6 

150 

9 

6.0 

1902 

1,027 

45 

4.4 

207 

16 

7.7 

1903 

1,361 

62 

4.6 

268 

22 

8.2 

1904 

1,752 

54 

3.1 

400 

31 

7.8 

1905 

1,737 

64 

3.7 

444 

43 

9.7 

1901-1905 

6,687 

254 

3.8 

1,469 

121 

8.2 

1906 

2,080 

92 

4.4 

504 

50 

9.9 

1907 

2,414 

115 

4.8 

529 

53 

10.0 

1908 

2,600 

134 

5.2 

631 

72 

11.4 

1909 

2,826 

166 

5.9 

640 

66 

10.3 

1910 

3,206 

181 

5.6 

740 

71 

9.6 

1906-1910 

13,126 

688 

5.2 

3,044 

312 

10.2 

1911 

3,542 

182 

5.1 

871 

81 

9.3 

1912 

3,800 

216 

5.7 

896 

108 

12.1 

1913 

4,115 

263 

6.4 

943 

124 

13.1 

345 


APPENDIX  D 

Table  20 
Ordinary  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America 
Mortality  from  Cancer,  by  Age  and  Sex 
1886-1913 


MALES 

FEMALES 

Deaths 

Deaths 

Deaths 

Deaths 

from  All 

from 

Cancer 

fromAU 

from 

Cancer 

Ages 

Causes 

Cancer 

Per  Cent. 

Causes 

Cancer 

Per  Cent. 

Under  20 

387 

2 

20 

0.5 
0.9 

109 
699 

5 

20-24 

2,262 

0.7 

25-29 

3,525 

39 

1.1 

1,082 

12 

1.1 

30-34 

4,256 

81 

1.9 

1,155 

51 

4.4 

35-39 

4,647 

147 

3.2 

1,015 

93 

9.2 

40-44 

4,437 

190 

4.3 

852 

139 

16.3 

45-49 

3,889 

281 

7.2 

723 

155 

21.4 

50-54 

3,515 

296 

8.4 

636 

121 

19.0 

55-59 

2,779 

249 

9.0 

551 

101 

18.3 

60-64 

2,070 

200 

9.7 

409 

55 

13.4 

65-69 

1,185 

120 

10.1 

213 

24 

11.3 

70-74 

389 

31 

7 

8.0 
9.0 

5.0 

68 

7 

8 
764 

11.8 

75  and  over 

78 

Total 

33,419 

1,663 

7,519 

10.2 

Table  21 
Ordinary  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America 
Mortality  from  Cancer,  by  Sex,  Organs  and  Parts,  and  Average  Age  at  Death 

1886-1913 


I^LALES 

FE>L\LES 

Number 

Aggregate 

Average 

Number 

Aggregate 

Average 

Organ  or  Part 

of 

Years 

Age  at 

of 

Years 

Age  at 

Deaths 

of  Life 

Death 

Deaths 

of  Life 

Death 

Buccal  ca\nty 

89 

4,493 

50.5 

Stomach  and  liver .... 

860 

44,280 

51.5 

179 

9,064 

50.6 

Peritoneum,     intestines 

and  rectum 

274 

13,343 

48.7 

95 

4,586 

48.3 

Female    generative    or- 

gans  

264 

12,214 

46.3 

Breast 

3 

lei 

53.7 

118 

5,479 

46.4 

Skin 

32 

1,607 

50.2 

5 

259 

51.8 

Other  organs 

354 

17,049 

48.2 

70 

3,180 

45.4 

Organs  not  specified .  .  . 

51 

2,490 

48.8 
.50.2 

33 

764 

1,512 

45.8 

All  organs 

1,663 

83,423 

36,294 

47.5 

346 


APPENDIX  D 

Table  22 
Ordinary  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America 
Mortality  from  Cancer,  by  Organs  and  Parts,  according  to  Sex  at  Divisional 

Periods  of  Life 

1886-1913 


MALES 

AGES  UNDER  35 

No.  of  Per 

Organ  or  Part                            Deaths  Cent. 

Buccal  cavity 4  2.8 

Stomach  and  liver 43  30.3 

Peritoneum,  intestines,  rectum ..  .         32  22.5 

Female  generative  organs 

Breast 

Skin 2  1.4 

Other  or  not  specified  organs 61  43.0 

All  organs 142  100.0 

AGES  35-44 

Buccal  cavity 23  6.8 

Stomach  and  liver 162  48.1 

Peritoneum,  intestines,  rectum ...        62  18.4 

Female  generative  organs 

Breast 

Skin 7  2.1 

Other  or  not  specified  organs 83  24.6 

All  organs 337  100.0 

AGES  45-64 

Buccal  cavity 57  5.6 

Stomach  and  liver 571  55.7 

Peritoneum,  'ntestines,  rectum .  .  .       155  15.1 

Female  generative  organs 

Breast 3  0.3 

Skin 22  2.1 

Other  or  not  specified  organs 218  21.2 

All  organs 1,026  100.0 


FEMALES 

No.  of 

Per 

Deaths 

Cent. 

ii 

16.2 

10 

14.7 

24 

35.3 

9 

13.2 

1 

1.5 

13 

19.1 

68 


100.0 


38 

16.4 

27 

11.6 

89 

38.4 

42 

18.1 

36 

15.5 

232 

100.0 

lis 

26.6 

53 

12.3 

148 

34.3 

62 

14.3 

3 

0.7 

51 

11.8 

432 


100.0 


347 


APPENDIX  D 

Table  22  (concluded) 
Ordinary  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America 
Mortality  from  Cancer,  by  Organs  and  Parts,  according  to  Sex  at  Divisional 

Periods  of  Life 
1886-1913 


MALES 
AGES  65  AND  OVER 

No.  of  Per 

Organ  or  Part                            Deaths  Cent, 

Buccal  ca\aty 5  3.2 

Stomach  and  liver 84  53.2 

Peritoneum,  intestines,  rectum .. .        25  15.8 

Female  generative  organs 

Breast 

Skin 1  0.6 

Other  or  not  specified  organs 43  27.0 

Allorgans 158  100.0 

ALL  AGES 

Buccal  cavity: 89  5.3 

Stomach  and  liver 860  51.7 

Peritoneum,  intestines,  rectum .  .  .      274  16.5 

Female  generative  organs 

Breast 3  0.2 

Skin 32  1.9 

Other  or  not  s|)ecified  organs 405  24.4 

All  organs 1,663  100.0 


FEMALES 

No.  of 

Per 

Deaths 

Cent. 

15 

46.9 

6 

15.6 

3 

9.4 

5 

15.6 

1 

3.1 

3 

9.4 

32 


100.0 


179 

23.4 

95 

12.4 

264 

34.6 

118 

15.4 

5 

0.7 

103 

13.5 

764 


100.0 


Table  23 
Ordinary  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America 
Mortality  from  Cancer  at  Divisional  Periods  of  Life,  by  Organs  and  Parts 

according  to  Sex 

1886-1913 


MALES 
BUCCAL  CAVITY 
No.  of  Per 

Ages  Deaths  Cent. 

Under  35 4  4.5 

35-44 23  25.8 

45-64 57  64.1 

65  and  over 5  5.6 

Total 89  100.0 

STOMACH  AND  LIVER 

Under  35 43  5.0 

35-44 162  18.8 

45-64 571  66.4 

65  and  over 84  9.8 

Total 860  100.0 


FEMALES 


No.  of 
Deaths 


Per 
Cent. 


11 

6.1 

38 

21.2 

115 

64.3 

15 

8.4 

179 


100.0 


348 


APPENDIX  D 

Table  23  (concluded) 
Ordinary  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America 
Mortality  from  Cancer  at  Divisional  Periods  of  Life,  by  Organs  and  Parts 

according  to  Sex 
1886-1913 


Ages 
Under  35... 

35-44 

45-64 

65  and  over. 

Total.. 


Under  35... 

35-44 

45-64 

65  and  over. 

Total.. 


MALES 
PERITONEUM,  INTESTINES  AND  RECTUM 


No.  of 
Deaths 

32 

62 

155 

25 


Per 

Cent. 

11.7 

22.6 

56.6 

9.1 


274  100.0 

FEMALE  GENERATIVE  ORGANS 


FEMALES 

No.  of 

Per 

Deaths 

Cent, 

10 

10.5 

27 

28.4 

53 

55.8 

5 

6.3 

95 


24 

89 

148 

3 


100.0 


9.1 
33.7 
56.1 

1.1 

100.0 


BREAST 


Under  35... 

35-44 

45-64 

65  and  over. 

Total. . 


Under  35... 

35-44 

45-64 

65  and  over. 

Total. . 


3 

100.0 

3 

100.0 

SKIN 

2 

6.3 

7 

21.9 

22 

68.7 

1 

3.1 

32 


100.0 


9 

7.6 

42 

35.6 

62 

52.6 

5 

4.2 

118 


100.0 


20.0 

60.6 
20.0 

100.0 


Under  35... 

35-44 

45-64 

65  and  over. 

Total.. 


OTHER  OR  NOT  SPECIFIED  ORGANS 


61 

15.1 

83 

20.5 

218 

53.8 

43 

10.6 

405 


100.0 


13 

12.6 

36 

35.0 

51 

49.5 

3 

2.9 

103 


100.0 


ALL  ORGANS  AND  PARTS 

Under  35 142  8.5 

35-44 337  20.3 

45-64 1,026  61.7 

65  and  over 158  9.5 


Total 1,663 


100.0 


68 

8.9 

232 

30.4 

432 

56.5 

32 

4.2 

764 


100.0 


349 


APPENDIX  D 

Table  24 
Ordinary  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America 
Mortality  from  Cancer,  by  Organs  and  Parts  at  Single  Years  of  Life,  Males 

1886-1913 


Age 
19.. 
20.. 

21.  . 

22.  . 

23.  . 

24.  . 

25.  . 


27. 
28. 
29. 
30. 
31. 
32. 
33. 
34. 
35. 
36. 
37. 
38. 
39. 
40. 
41. 
42. 
43. 
44. 
45. 
46. 
47. 
48. 
49. 
50. 
51. 
52. 
53. 
54. 
55. 
56. 
57. 
58. 
59. 


Stomach  Peritoneum 

Organs 

Buccal 

and 

Intestines 

Other 

not 

Ca\ 

aty 

Liver 

Rectum       Breast          Skin 

Organs 

Specified 

Total 

1 

4 

2 
4 

i 

4 

5 

3 

4 

4 
4 

i 

2 

3 

3 

1 

5 

3 

2 

2 

7 

1 

4 

3 

9 

1 

2 

1 

2 

7 

1 

2 

3 

3 

11 

4 

4 

6 

14 

2 

5 

4 

4 

16 

9 

1 

5 

16 

5 

5 

7 

18 

9 

2 

6 

17 

1 

10 

3 

5 

20 

2 

11 

11 

8 

32 

16 

7 

8 

32 

2 

17 

6 

11 

37 

1 

16 

2 

6 

26 

3 

18 

13 

1 

8 

43 

16 

6 

1 

7 

31 

7 

16 

1 

3 

8 

38 

2 

21 

6 

1 

6 

38 

5 

21 

7 

3 

40 

3 

33 

7 

1               1 

5 

51 

3 

24 

11 

2 

11 

52 

4 

27 

16 

18 

66 

1 

26 

7 

2 

18 

54 

4 

36 

6 

11 

58 

2 

28 

13 

1   . 

14 

59 

3 

38 

4 

10 

56 

2 

34 

6 

2 

13 

59 

43 

10 

2 

14 

72 

3 

30 

7 

1 

8 

50 

3 

26 

9 

2 

6 

46 

5 

30 

•6 

2 

11 

56 

7 

31 

8 

4 

51 

5 

26 

9 

2 

11 

53 

2 

25 

4 

2 

9 

43 

350 


APPENDIX  D 

Table  24  (concluded) 
Ordinary  Mortality  Experience  of  Tlie  Prudential  Insurance  Company  of 

America 
Mortality  from  Cancer,  by  Organs  and  Parts  at  Single  Years  of  Life,  Males 

1886-191S 


Age 

Buccal 
Cav-ity 

Stomach  Peritoneum 
and        Intestines 
Liver         Rectum       Breast          Skin 

Other 
Organs 

Organs 

not 
Specified 

Total 

60 

2 

28 

4 

1 

8 

43 

61 

3 

29 

10 

1 

8 

4 

55 

62 

3 

22 

7 

9 

3 

44 

63 

1 

21 

7 

3 

1 

33 

64 

1 

14 

4 

3 

3 

25 

65 

1 

23 

6 

8 

1 

39 

66 

1 

13 

4 

1 

7 

3 

29 

67 

1 

12 

6 

6 

1 

26 

68 

8 

3 

4 

15 

69 

8 

1 

2 

11 

70 

1 

4 

1 

4 

10 

71 

5 

2 

3 

10 

72 

1 

5 

1 

i 

8 

73 

1 

1 

2 

74 

1 

1 

75 

3 

3 

76 

2 

2 

77 

1 

i 

2 

Total .... 

.  .  . .     89 

860 

274 

3            32 

354 

51 

1,663 

351 


APPENDIX  D 

Table  25 
Ordinary  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America 
Mortality  from  Cancer,  by  Organs  and  Parts  at  Single  Years  of  Life,  Females 

1886-1913 


Stomach  Peritoneum 

Female 

Organs 

Buccal           and           Intest. 

Gener. 

Other 

not 

Age               Cavity         Li 

ver         Rectum 

Organs       Breast           Skin         Organs 

Specified 

Total 

19 

. 

20 

21 

i 

1 

22 

1 

!              '..               2 

3 

23 

1 

1 

24 

25 

'.               2 

2 

26 

27 

1 

1 

28 

2 

"i 

3 

29 

2 

2 

'.             '.'.               2 

6 

30 

1               1 

3 

3 

8 

31 

1               1 

3 

1             ..               1 

i 

8 

32 

1               1 

4 

2             ..               1 

9 

33 

3 

4 

4               1 

12 

34 

2              3 

4 

2 

3 

14 

35 

2              1 

8 

1                              3 

1 

16 

36 

3              2 

5 

3             ..               1 

14 

37 

2              1 

7 

7             ..               1 

'2 

20 

38 

6 

9 

4             ..               3 

22 

39 

4              7 

5 

1                              3 

i 

21 

40 

2              1 

13 

5             ..               3 

2 

26 

41 

3              5 

9 

4             ..               2 

23 

42 

4              3 

16 

7             ..               2 

2 

34 

43 

2              1 

8 

7.-3 

1 

22 

44 

10              6 

9 

3             ..               3 

3 

34 

45 

7 

16 

4             ..               1 

2 

30 

46 

6              2 

15 

7             ..               1 

3 

34 

47 

6              4 

9 

8             ..               7 

1 

35 

48 

7               4 

12 

7                              5 

1 

36 

49 

7              2 

6 

3               1               1 

20 

50 

2              7 

7 

5              ..                1 

22 

51 

7               2 

5 

3               1               2 

20 

52 

7              2 

12 

4              ..                3 

28 

53 

7              7 

10 

6              ..                1 

'2 

33 

54 

9               1 

3 

2              ..                2 

1 

18 

55 

5              3 

8 

4             ..               1 

1 

22 

56 

4              2 

9 

4 

1 

20 

57 

10              3 

5 

1 

2 

21 

58 

9               3 

8 

1             ..               1 

22 

59 

5               1 

5 

2               1               2 

16 

352 


APPENDIX  D 

Table  25  (concluded) 

Ordinary  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America 
Mortality  from  Cancer,  by  Organs  and  Parts  at  Single  Years  of  Life,  Females 

1886-1913 


Age 

Bu( 
Ca\ 

'cal 

aty 

Stomach  Peritoneum 

and           Intest. 

Liver         Rectum 

Female 
Gener. 
Organs 

Breast 

Skin 

Other 
Organs 

Organs 

not 
Specified 

Total 

60 

2 

1 

1 

1 

5 

61.. 

5 

3 

6 

2 

,   , 

1 

17 

62.. 

4 

1 

8 

2 

15 

63.. 

2 

1 

2 

1 

,    , 

"i 

i 

8 

64.. 

4 

4 

1 

1 

10 

65.. 

1 

3 

1 

i 

6 

66.. 

5 

,   , 

1 

6 

67.. 

4 

*i 

i 

6 

68.. 

1 

i 

i 

i 

4 

69.. 

1 

1 

,  , 

2 

70.. 

2 

.  , 

"i 

3 

71.. 

. . . 

1 

i 

,  , 

2 

72.. 

i 

,  , 

i 

2 

73.. 

i 

.. 

1 

Total. 

179 

95 

264 

118 

5 

70 

S3 

764 

353 


APPENDIX  D 

Table  26 
Ordinary  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America 

Anthropometry  in  Mortality  from  Cancer,  Males 

Weights  and  Age  at  Entry 

1886-1912 


DISTRIBUTION 

PER 

10,000 

DEATHS  FROM  CANCER 

—Ages  at  Entry- 

Weight 

5           20 

25 

30 

35 

40 

45 

50 

55 

60 

65 

at                        to           to 

to 

to 

to 

to 

to 

to 

to 

to 

and 

Entry                       ] 

9           24 

29 

34 

39 

44 

49 

54 

59 

64 

Over 

Total 

Under  110.. 

7 

7 

110-119. .. 

7 

'7 

14 

21 

'7 

21 

"7 

"7 

91 

120-129. .. 

14        57 

21 

50 

57 

29 

29 

29 

286 

130-139 

. .     21        43 

64 

107 

215 

172 

129 

150 

79 

2i 

'7 

1,008 

140-149 

. .      14        57 

157 

229 

301 

309 

394 

236 

150 

79 

14 

1,940 

150-159. .. 

57 

143 

186 

215 

323 

215 

352 

215 

72 

7 

1,785 

160-169. .  . 

50 

93 

114 

280 

337 

287 

266 

114 

136 

43 

1,720 

170-179 

14 

79 

150 

179 

250 

143 

207 

122 

64 

1,208 

180-189 

21 

36 

29 

150 

157 

143 

122 

86 

43 

14 

801 

190-199 

7 

14 

43 

79 

107 

93 

100 

57 

36 

536 

200-209 

7 

21 

43 

64 

64 

43 

43 

29 

314 

210-219 

"7 

14 

14 

29 

64 

14 

36 

178 

220-229 

7 

14 

14 

14 

7 

7 

63 

230-239 

7 

7 

14 

7 

14 

'7 

56 

240-249 . . . 

250-259 . . . 

260  and  over 

'7 

"7 

Total.  . 

f 

)6      320 

635 

957 

1,575 

1,791 

1,596  1,532 

959 

494 

85 

10,000 

D 

ISTRIBUTION  PER  10,000  DEATHS 

FROM 

ALL 

CAUSES 

Under  110.. 

..      ] 

6          3 

2 

3 

2 

1 

1 

1 

29 

110-119 

i 

J2        25 

22 

9 

11 

5 

6 

7 

4 

'2 

i 

124 

120-129 

, . 

rS      126 

92 

75 

57 

39 

31 

22 

15 

10 

1 

546 

130-139 

..   K 

)3      256 

266 

215 

180 

120 

100 

78 

57 

21 

5 

1,401 

140-149 

..   1( 

)6      305 

339 

289 

245 

203 

171 

130 

104 

46 

8 

1,946 

150-159 

1 

il      252 

316 

299 

256 

219 

173 

143 

103 

37 

6 

1,855 

160-169 

'.'.     i 

>4      158 

223 

258 

257 

221 

162 

133 

94 

37 

8' 

1,575 

170-179 

6        71 

137 

160 

160 

135 

115 

94 

75 

24 

6 

983 

180-189 

4        33 

82 

81 

107 

106 

93 

76 

70 

21 

6 

679 

190-199 

14 

30 

57 

68 

62 

58 

48 

36 

15 

3 

391 

200-209 

5 

15 

31 

29 

41 

34 

25 

21 

9 

2 

212 

210-219 

2 

6 

19 

23 

19 

27 

21 

13 

6 

1 

137 

220-229 

1 

4 

7 

10 

16 

15 

13 

5 

2 

73 

230-239 

2 

5 

6 

5 

5 

3 

5 

2 

33 

240-249 

2 

2 

2 

1 

2 

1 

1 

11 

250-259 

i 

2 

1 

4 

260  and  over 

"i 

47 

1 

Total .  . 

.  .  4i 

JO  1,251 

1,537 

1,512 

1,414 

1,194 

991 

797 

604 

233 

10,000 

S54 


APPENDIX  D 

Table  27 
Ordinary  Mortality  Experience  of  The  Prudential  Insurance  Company  of 

America 
Family  History  in  Mortality,  Cancer  Compared  with  Tuberculosis,  Males 

1886-1912 


DISTRIBUTION 

PER  10,000  DEATHS  FROM 

CANCER 

\rrr 

of  Insured  at 
50-59 

Age  of  Father 
at  His  Death 

20-i29 

30-39 

40-49 

60-63 

70-79 

Total 

20-29 

10 

39 

29 

39 

10 

10 

137 

30-39 

19 

58 

155 

155 

107 

19 

513 

40-49 

58 

136 

214 

408 

291 

29 

1,136 

50-59 

29 

204 

495 

505 

320 

21 

1,574 

60-69 

39 

262 

932 

1,097 

544 

87 

2,961 

70-79 

10 

165 

553 

1,039 

689 

87 

2,543 

80-89 

49 

214 

427 

301 

19 

1,010 

90-99 

10 

58 

39 

19 

291 

126 

Total 

165 

923 

2,592 

3,728 

2,301 

10,000 

Age  of  Mother 
at  Her  Death 

20-29 

30-39 

40-49 

50-59 

60-69 

70-79 

Total 

20-29 

68 

113 

34 

11 

226 

30-39 

ii 

169 

248 

259 

180 

23 

890 

40-49 

45 

248 

417 

530 

316 

1,556 

50-59 

11 

214 

519 

496 

225 

23 

1,488 

60-69 

169 

710 

1,026 

440 

56 

2,401 

70-79 

90 

372 

981 

936 

68 

2,447 

80-89 

23 

113 

293 

316 

79 

824 

90-99 

11 

56 

90 

11 
271 

168 

Total 

67 

913 

2,458 

3,754 

2,537 

10,000 

DISTRIBUTION  PER  10,000  DEATHS  FROM  TUBERCULOSIS  OF  THE  LUNGS 
Age  of  Father 

at  His  Death                                 20-29  30-39  40-49  50-59  60-69  70-79  Total 

20-29 66  69  21  17  .  .  .'.  173 

30-39 345  324  204  72  17  . .  962 

40-49 770  787  390  173  35  . .  2,155 

50-59 614  1,022  639  207  52  3  2,537 

60-69 293  808  680  352  97  17  2,247 

70-79 93  352  452  345  76  14  1,332 

80-89 17  86  173  173  55  7  511 

90-99 17  35  21  10  .  .  83 

Total 2,198  3,465  2,594  1,360  342  41  10,000 

Age  of  Mother 

at  Her  Death                                20-29  30-39  40-49  50-59  60-69  70-79  Total 

20-29 153  134  81  32  5  .  .  405 

30-39 599  604  396  167  27  9  1,802 

40-49 676  887  450  189  59  5  2,266 

50-59 387  910  568  234  50  13  2,162 

60-69 90  604  725  410  85  5  1,919 

70-79 18  126  432  423  153  23  1,175 

80-89 14  54  108  54  . .  230 

90-99 5  18  14  4  ..  41 

Total 1,923  3,284  2,724  1,577  437  55  10,000 


355 


APPENDIX  D 

Table  28 

Mortality  Experience  of  American  Life  Insurance  Companies 

Medico-Actuarial  Mortality  Investigation,  New  York,  1913 

Mortality  from  Cancer,  according  to  Build,  Males 

1885-1908 


Overweight  50 
PouNoa  AND  More 

Standard  Lives 

Underweight  25 
Pounds  and  More 

Age  at  Entry 

Deaths 
from 
Cancer 

Rate  per 

10,000 

Exposed 

to  Risk 

Deaths 
from 
Cancer 

Rate  per 
10,000 

Exposed 
to  Risk 

Deaths 

from 
Cancer 

Rate  per 
10,000 

Exposed 
to  Risk 

15-29 

6 

0.9 

95 

1.0 

39 

0.8 

30-44...... 

87 

3.7 

377 

3.2 

242 

2.4 

45  and  over. 

107 

15.6            411 

Cancer ' 
Per  Cent,  of 
All  Causes 

14.4           216 

Cancer 
Per  Cent,  of 
All  Causes 

12.0 

Cancer 
Per  Cent,  of 
All  Causes 

15-29  

1.7 

2.1 

1.4 

30-44 

3.4 

4.8 

3.4 

45  and  over 

6.0 

7.7 

7.3 

Source: 

Medico-Actuarial  Mortality  Investigation,  Vol.  II,  p.  34. 

New  York,  1913. 

Table  29 
Mortality  Experience  of  American  Life  Insurance  Companies 

Medico-Actuarial  Mortality  Investigation,  New  York,  1913 
Mortality  from  Cancer  and  other  Malignant  Tumors,  by  Sex 

1885-1908 


MALES 


Policy 
Years 

1 

2 

3-5 ... . 

6-10. . . 

11-24. . . 

Total. 

1 

2 

3-5  ... 

6-10. . . 

11-24. . . 

Total. 


Number  of  Policies 
Terminated  by  Death 

. Ages  at  Entry 

15-29      30-44  45-over 


4 

4 
18 
30 
39 


7 

25 

72 

105 

168 


15 

42 

111 

129 

114 


Percentage  of 
All  Deaths 


. Ages  at  Entry . 

15-29    30-44  45-over 

1.0      3.5 

3.6 

3.9 

4.7 

7.0 


0.6 
0.7 
1.4 
2.5 
4.1 


9.4 
8.9 
7.8 
7.3 


95        377      411  2.1      4.8      7.7 

FEMALES 


Rate  per  10,000 
Exposed  to  Risk 

. Ages  at  Entry . 

15-29  30-44  45-over 

0.2  0.4  3.2 

0.3  1.9  12.0 

0.7  2.3  13.6 

1.2  3.3  16.4 

2.3  7.6  26.3 


7 

50 

55 

1.1 

6.4 

13.6 

5 

52 

64 

0.9 

6.9 

15.8 

24 

199 

196 

1.9 

11.0 

15.2 

26 

240 

212 

3.0 

15.6 

13.1 

36 

127 

127 

11.5 

16.3 

10.5 

98 

668 

654 

2.7 

11.8 

13.3 

1.0 


0.5 
0.5 
1.0 
1.6 

7.2 

1.4 


3.2       14.4 


3.0  12.1 

4.0  18.1 

6.6  23.5 

10.3  28.8 

15.4  40.7 

7.3  24.3 


Source:     Medico- Actuarial  Mortality  Investigation,  Vol.  II,  p.  31,  et  seq.    New 
York,  1913 


356 


APPENDIX  D 

Table  30 
Mortality  Experience  of  Twenty-seven  American  Insurance  Companies 
(Meech)  from  Organization  to  1873 
Mortality  from  Cancer,  with  Distinction  of  Age  and  Sex 


MALES  AND  FEMALES 


Ages 

10-19 

20-29 

30-39 

40-49 

50-59 

60-69 

70-79 

80  and  over 

Total 37,624 

IVMLES 

10-19 133 

20-29 

30-39 

40-49 

50-59 

60-69 

70-79 

80  and  over 

Total 35,442 

FEMALES 

10-19 18 

20-29 360 

30-39 698 

40-49 563 

50-59 317 

60-69 164 

70-79 51 

80  and  over 11 

Total 2,182 


Deaths 

Deaths 

from  All 

from 

Cancer 

Causes 

Cancer 

Per  Cent. 

151 

,  , 

3,836 

9 

0.2 

10,019 

77 

0.8 

11,403 

210 

1.8 

7,893 

255 

3.2 

3,521 

111 

3.2 

698 

22 

3.2 

103 

•• 

684 


632 


1.8 


3,476 

8 

0.2 

9,321 

72 

0.8 

10,840 

186 

1.7 

7,576 

239 

3.2 

3,357 

107 

3.2 

647 

20 

3.1 

92 

•• 

1.8 


1 

0.3 

5 

0.7 

24 

4.3 

16 

6.0 

4 

2.4 

2 

3.9 

52 


2.4 


357 


APPENDIX  D 

Table  31 

Mortality  Experience  of  The  Aetna  Life  Insurance  Company 

Mortality  from  Cancer 

1870-1913 


Year 

1870 

1871 

1872 

1873 

1874 

1875 

1876 

1877 

1878 

1879 

1880 

1881 

1882 

1883 

1884 

1885 

1886 

1887 

1888 

1889 

1890 

1891 

1892 

1893 

1894 

1895 

1896 

1897 

1898 

1899 

1900 

1901 

1902 

1903 

1904 

1905 

1906 

1907 

1908 

1909 

1910 

1911 

1912 

1913 

1870-1890. 
1891-1913. 


Deaths 

Deaths 

from  All 

from 

Cancer 

Causes 

Cancer 

Per  Cent. 

426 

11 

2.6 

432 

7 

1.6 

486 

8 

4.6 

579 

18 

3.1 

474 

10 

2.1 

527 

16 

3.0 

536 

14 

2.6 

544 

15 

2.8 

502 

20 

4.0 

532 

23 

4.3 

542 

23 

4.2 

503 

20 

3.4 

565 

23 

4.1 

656 

37 

53 

645 

27 

4.2 

667 

30 

4.5 

715 

36 

5.0 

719 

34 

4.9 

783 

23 

2.9 

761 

37 

4.9 

817 

34 

4.2 

897 

45 

5.0 

1,019 

51 

5.0 

1,013 

48 

4.7 

956 

53 

5.5 

1,052 

40 

3.8 

1,029 

40 

3.9 

1,044 

65 

5.3 

1,051 

48 

4.6 

1,114 

54 

4.8 

1,215 

83 

6.8 

1,303 

84 

6.4 

1,267 

55 

4.3 

1,386 

87 

6.3 

1,432 

70 

4.9 

1,388 

97 

7.0 

1,514 

111 

7.3 

1,536 

104 

6.8 

1,504 

117 

7.8 

1,605 

112 

7.0 

1,783 

122 

6.8 

1,702 

127 

7.5 

1,628 

123 

7.6 

1,658 

117 

7.1 

12,411 

466 

3.8 

30,096 

1,843 

6.1 

358 


APPENDIX  D 

Table  32 

Mortality  Experience  of  The  Mutual  Life  Insurance  Company  of  New  York 

Mortality  from  Cancer,  by  Age  and  Sex 

1843-1914 


MALES 


Ages 

Undergo. 
20-24.... 
25-29.... 
30-34. . . . 
35-39. . . . 

40-44 

45-49. .  .  . 
50-54.... 
55-59.... 
60-64.... 
65-69. . . . 
70-74.... 
75-79.... 
80-84.... 


85  and  over. 


Deaths 

Deaths 

from  All 

from 

Cancer 

Causes 

Cancer 

Per  Cent 

252 

3 

1.19 

1,874 

15 

0.80 

4,693 

48 

1.02 

7,258 

106 

1.46 

10,058 

269 

2.67 

11,750 

469 

3.99 

13,103 

690 

5.27 

14,001 

1,005 

7.18 

14,300 

1,112 

7.78 

13,668 

1,086 

7.95 

12,625 

875 

6.93 

10,152 

628 

6.19 

7,382 

386 

5.23 

4,071 

130 

3.19 

1,870 

52 

2.78 

FEMALES 

Deaths 
from  All 
Causes 

Deaths 

from 
Cancer 

Cancer 
Per  Cent 

18 

151 

2 

1.32 

413 

4 

0.97 

647 

18 

2.78 

720 

56 

7.78 

802 

104 

12.97 

764 

136 

17.80 

730 

136 

18.63 

725 

138 

19.03 

701 

97 

13.84 

612 

71 

11.60 

448 

46 

10.27 

339 

15 

4.42 

163 

7 

4.29 

69 

•• 

830 


11.37 


Total 127,079*       6,874  5.41  7,303t 

Source:    Report  on  the  Mortality  Records  of  The  Mutual  Life  Insurance  Company 
of  New  York  from  1843  to  1898.      New  York,  1900.      1899-1914,  courtesy  of  Brandreth 
Symonds,  Chief  Medical  Director  of  The  Mutual  Life  Insurance  Company  of  New  York. 
•Including  22  age  not  stated.      tincluding  1  age  not  stated. 


Table  33 

Mortality  Experience  of  The  Mutual  Life  Insurance  Company  of  New  York 

Mortality  from  Cancer,  by  Age  and  Sex 

1843-1914 


MALES 


All  Ages 

Deaths      Deaths  Cancer 
from  All      from        Per 
Causes      Cancer    Cenf. 

1843-1873 5,223*        94  1.80 

1874-1885 10,839        449  4.14 

1886-1893 14,568        631  4.33 

1894-1898 14,355        708  4.93 

1899-1914 82,094    4,992  6.09 


1843-1914 127,079*  6,874     5.41  35,885     910     2.54 


Under  45 


Deaths 
from  All 
Causes 

2,674 
3,028 
3,658 
4,263 

22,262 


Deaths  Cancer 

from        Per 
Cancer    Cent. 

25     0.93 


71 

65 

95 

654 


2.34 
1.78 
2.23 
2.94 


FEMALES 


162t 

247 

456 

675 

1899-1914 5,763 


1843-1873. 
1874-1885. 
1886-1893. 
1894-1898. 


8     4.94 

24     9.72 

45     9.87 

50     7.41 

703  12.23 


76 

5 

6.58 

85 

3 

74 

4 

5.41 

173 

20 

147 

10 

6.80 

309 

35 

265 

6 

2.26 

410 

44 

2,189 

159 

7.26 

3,574 

544 

Deaths 
from  All 
Causes 

2,527 

7,811 

10,910 

10,092 

59,832 


Deaths 
from 
Cancer 


45  AND  Over 

Cancer 
Per 
Cent. 

69       2.72 

378       4.84 

566 

613 

4,338 


5.19 
6.07 

7.25 


91,172     5,964       6.54 


3.53 
11.56 
11.33 
10.73 
15.22 


1843-1914 7,303t      830  11.37  2,751     184     6.69  4,551        646     14.19 

Source:  Report  on  the  Mortality  Records  of  The  Mutual  Life  Insurance  Company 
of  New  York  from  1843  to  1898.  New  York,  1900.  1899-1914,  courtesy  of  Brandreth 
Symonds,  Chief  Medical  Director  of  The  Mutual  Life  Insurance  Company  of  New  York. 

*Including  22  age  not  given.      flncluding  1  age  not  stated. 


359 


APPENDIX  D 

Table  34 

Mortality  Experience  of  The  Mutual  Life  Insurance  Company  of  New  York 

Mortality  from  Other  Tumors,  by  Age  and  Sex 

1843-1898 


. 

MALES 

FEMALES 

Deaths 

Deaths 

f-' 

Deaths 

Deaths 

from  All 

from 

Tumor 

from  AH 

from 

Tumor 

Ages 

Causes 

Tumor 

Per  Cent. 

Causes 

Tumor 

Per  Cent. 

Under  20 

38 

•• 

2 
30 

20-24 

569 

25-29 

1,775 

4 

0.23 

78 

30-34 

2,900 

5 

0.17 

136 

1 

0.73 

35-39 

4,034 

18 

0.45 

141 

40-44 

4,307 

12 

0.28 

175 

2 

1.14 

45-49 

4,621 

17 

0.37 

156 

50-54 

4,944 

13 

0.26 

159 

55-59 

5,283 

9 

0.17 

185 

60-64 

5,016 

12 

0.24 

160 

2 

1.25 

65-69 

4,593 

16 

0.35 

122 

2 

1.64 

70-74 

3,406 

10 

0.29 

71 

1 

1.41 

75-79 

2,212 

1 

0.05 

92 

80-84 

956 

1 

0.10 

25 

85  and  over 

309 

2 
120 

0.65 
0.27 

7 

8 

Total 

44,985* 

l,540t 

0.52 

Source:     Report  on  the  Mortality  Records  of  The  Mutual  Life  Insurance  Company  of 
New  York  from  1843  to  1898.     New  York,  1900. 

•Including  22  age  not  stated.      tlncluding  1  age  not  stated. 


Table  35 

Mortality  Experience  of  The  New  York  Life  Insurance  Company 

Mortality  from  Cancer  and  Other  Tumors 

1901-1913 


Deaths  Deaths  from 

from  All  Cancer  and  Per 

Year  Causes  Other  Tumors  Cent. 

1901 4,593  206  4.5 

1902 5,094  253  5.0 

1903 5,573  289  5.2 

1904 6,632  339  5.1 

1905 7,701  370  4.8 

1906 7,244  384  5.3 

1907 7,593  401  5.3 

1908 7,568  480  6.3 

1909 7,719  575  7.4 

1910 8,039  588  7.3 

1911 8,314  606  7.3 

1912 8,549  631  7.4 

1913 8,793  660  7.5 


Furnished  by  Mr.  Arthur  Hunter,  Actu- 
ary of  The  New  York  Life  Insurance 
Company. 


360 


APPENDIX  D 

Table  36 

Mortality  Experience  of  The  Northwestern  Mutual  Life  Insurance  Company 

Mortality  from  Cancer,  by  Age,  Males 

1857-1909 


1857-1885 

1886-1909 

Deaths 

Deaths 

Deaths 

Deaths 

from  All 

from 

Cancer 

from  All 

from 

Cancer 

Ages 

Causes 

Cancer 

Per  Cent. 

Causes 

Cancer 

Per  Cent. 

Under  20     

22 

32 
2,195 

24 

20-29 

388 

1.1 

30-39 

1,099 

18 

1.6 

4,832 

107 

2.2 

40-49 

1,541 

59 

3.8 

6,327 

335 

5.3 

50-59 

1,381 

63 

4.6 

6,624 

525 

7.9 

60-69 

792 

39 

4.9 

5,982 

529 

8.8 

70-79 

141 

6 

4.3 

3,897 

248 

6.4 

80  and  over 

3 

185 

3.4 

1.172 

32 

2.7 

Total 

5,367 

31,061 

1,800 

5.8 

Table  37 

Mortality  Experience  of  The  Washington  Life  Insurance  Company 

Mortality  from  Cancer,  by  Age 

1860- 1S86 


Ages 

19-29 

30-39 

40-49 

50-59 

60-69 

70-81 

Total 

Source:     The    Washington    Life    Insurance 
Medical  Statistics.     New  York,  1889. 

Note — During  this  same  period  there  were  seven  deaths  from  tumors,  the  deaths  from 
this  cause  representing  0.35%  of  the  total  mortality. 


Deaths 
from  All 
Causes 

Deaths 

from 

Cancer 

Cancer 
Per  Cent 

139 

1 

0.7 

413 

5 

1.2 

593 

15 

2.5 

451 

24 

5.3 

303 

18 

5.9 

101 

5 

68 

4.9 

2,000 

3.4 

ipany: 

Historical,    Actuarial    anc 

Table  38 
Mortality  from  Cancer  in  Foreign  Life  Insurance  Companies 


Deaths 
Number  of  from  All 

Companies  Causes 

16  German  companies 137,609 

1  Swiss  company 1,253 

1  Japanese  company 7,473 

13  Austrian  companies 85,334 

1  Dutch  East  Indian  company 161 

1  Hungarian  company. 3,117 

1  British  Indian  company 1,435 

Source:     Annual  Reports  of  the  several  companies. 


from 

Cancer 

Cancer 

Per  Cent 

15,191 

11.0 

129 

10.3 

709 

9.5 

8,052 

9.4 

15 

9.3 

253 

8.1 

22 

1.5 

361 


APPENDIX  D 

Table  39 
Mortality  from  Cancer  in  the  Experience  of  Thirty-four  Insurance 

Companies 

Deaths        Deaths    Cancer 
No  Period  Companies  from  All         from  Per 

Causes        Cancer      Cent. 

1.  1903—1912     GothaerLebensversicherungsbank,  Gotha,  Ger- 

many       20,030       2,518       12.6 

2.  1907-1912     Deutsche  Lebensversicherung,  Potsdam,  Ger- 

many         4,092  510       12.5 

3.  1893-1913     Leipziger    Lebensversicherungs  -  Gesellschaft, 

Leipzig,  Germany 22,456       2,770       12.3 

4.  1905-1912    Teutonia  Versicherungs  -  Actien  -  Gesellschaft, 

Leipzig,  Germany '. 9,780       1,166       11.9 

5.  1906-1913     Deutsche    Lebensversicherungs  -  Gesellschaft, 

Lubeck,  Germany 6,729  791       11.8 

6.  1901-1906     Stuttgarter    Lebensversicherungsbank,    Stutt- 

gart, Germany 6,953  817       11.8 

7.  1907-1913     "Concordia"  Mutual  Life  Insurance  Company, 

Reichenberg,  Austria 1,018  118       11.6 

8.  1900-1912     Erster  Allgemeiner  Beamten-Verein  der  Oster- 

reichisch-Ungarischen    Monarchic,    Vienna, 

Austria 17,507       2,000       11.4 

9.  1896-1913     Friedrich  Wilhelm,  Berlin,  Germany 10,332       1,113       10.8 

10.  1900-1905     Karlsruher     Lebensversicherung,      Karlsruhe, 

Germany 6,790  723       10.6 

11.  1908-1912     "Donau,"  Vienna,  Austria 2,164  227       10.5 

12.  1901-1913     "La  Suisse"  Societe  d' Assurances  sur  la  vie  et 

con tre  les  accidents,  Lausanne,  Switzerland .  .        1,253  129       10.3 

13.  1901-1913     Magdeburger     Lebensversicherungs   -   Gesell- 

schaft, Magdeburg,  Germany 10,215       1,039       10.2 

14      1907-1912     "Janus"    Mutual    Life    Insurance    Company, 

Vienna,  Austria .8,678  370       10.1 

15.  1896-1913     Lebens  -  und  Pensions  -  Versicherungs  -  Gesell- 

schaft "Janus,"  Hamburg,  Germany 9,172  921       10.0 

16.  1907—1913     "Freia"  Bremen-Hannoversche  Lebensversich- 

erungs-Bank,  Hanover,  Germany 3,981  387         9.7 

17.  1900-1907     "Praha"    Mutual    Life    Insurance  Company, 

Prague,  Austria 1,424  138         9.7 

18.  1908-1911     Lebensversicherungs-Anstalt  und   Sterbekasse 

des  Deutschen  Kriegerbundes,  Berlin,  Ger- 
many          6,513  625         9.6 

19.  1903—1906     Sachsischer       Militar       Lebensversicherungs- 

Verein,  Dresden,  Germany 2,419  230         9.5 

20.  1901-1912     Osterreichischer  Phoenix,  Life  Insurance  Com- 

pany, Vienna,  Austria 10,624       1,008         9.5 

21.  1899-1912     Assicurazioni  Generali,  Trieste,  Austria 15,622       1,461         9.4 

22.  1911-1913     Nederlandsch  -  Indische    Lebensverzekeringen 

Lijf rente  Maatschappij,  Batavia,  Dutch  East 

Indies 161  15         9.3 

23.  1905-1912     Mutual  Insurance  Company,  Krakau,  Austria       4,174  385         9.2 

24.  1907-1912     "Universale"  Industrial  Insurance  Company, 

Vienna,  Austria 8,594  790         9.2 


362 


APPEXDIX  D 

Table  39  (concluded) 
Mortality  from   Cancer   in  the  Experience  of  Thirty-four  Insurance 

Companies 

Deaths        Deaths    Cancer 
No.  Period  Companies  from  All        from         Per 

Causes        Cancer      Cent. 

25.     1903-191.3     "Victoria"    zii    Berlin,    Insurance    Company, 

Berlin,  Germany ." .      15,733       1,385         8.8 

2G.  1904-1912  Niederosterreichische  Landes  -  Lebens  und 
Renten-Versicherimgs-Anstalt,  Vienna,  Aus- 
tria         1,451  126         8.7 

27.  1899-1912     Riunione  Adriatica  di  Sicurta,  Trieste,  Austria .       9,454  811         8.6 

28.  1906—1913     "Deutschland"     Life     Insurance      Company, 

Berlin,  Germany 2,010  168         8.4 

29.  1900-1912     "Fonciere"  Pester  Versichenings-Anstalt,  Bu- 

dapest, Hungary 3,117  253         8.1 

30.  1906-1912     Landes-Lebensversicherungs-Anstalt  der  Mark- 

grafschaft  Maehren,  Bruenn,  Austria •.        1,466  104         7.1 

31.  1904—1913     "Atlas"    Life  Insurance  Company,    Ludwigs- 

hafen,  Germany 404  28         6.9 

32.  1901-1913     Lebens-und    Rentenversicherungs-Gesellschaft 

"Der  Anker,"  Vienna,  Austria 8,158  514         6.3 

33.  1911-1912     Oriental  Government  Security  Life  Assurance 

Company,  Ltd.,  Bombay,  British  India 1,435  22         1.5 

34.  1899-1907     Meiji  Life  Assurance  Company,  Tokio,  Japan .  .        7,473  709         9.5 

Source:     Annual  Reports  of  the  several  companies. 

Table  40 

Mortality  Experience  of  The  British  Empire  Mutual  Life  Assurance  Company 

Mortality  from  Cancer  and  Tumor,  by  Age 

1847-1872 


Cancer 

Tdmor 

Deaths 

Deaths 

Deaths               Tumor 

from  Ail 

from 

Cancer 

from                    Per 

Ages 

Causes 

Cancer 

Per  Cent. 

Tumor                Cent. 

Under  20 

5 

20-24 

34 

25-29 

100 

1                 1.0 

30-34 

170 

1 

0.6 

35-39 

247 

2                0.8 

40-44 

272 

8 

2.9 

3                 1.1 

45-49 

280 

9 

3.2 

2                 0.7 

50-54 

271 

9 

3.3 

3                 1.1 

55-59 

230 

11 

4.8 

2                 0.9 

60-64 

153 

1 

0.7 

1                 0.7 

65-€9 

112 

3 

2.7 

70-74 

73 

1 

1.4 

75-79 

35 

80  and  over 

17 

43 

2.2 

Total 

1,999 

14                 0.7 

Source:     Tables  of  the  Mortality  Experience  of  The  British  Empire  Mutual  Life 
Assurance  Company  from  1847  to  1884. 


363 


APPENDIX  D 

Table  41 

Mortality  Experience  of  Tlie  Britisli  Empire  Mutual  Life  Assurance  Company 

Mortality  from  Cancer  and  Tumor,  by  Age 

1873-1878 


Cancer 

TUMOH 

Ages 

Deaths 
from  All 

Causes 

Deaths 
from 
Cancer 

Cancer 
Per  Cent. 

Deaths 

from 
Tumor 

Tumor 
Per  Cent. 

Under  25 

3 

25-29 

24 

30-34 

49 

i 

2.6 

35-39 

80 

1 

1.3 

i 

1.3 

40-44 

87 

2 

2.3 

45-49 

109 

2 

1.8 

i 

0.9 

60-54 

154 

4 

2.6 

1 

0.6 

65-59 

185 

9 

4.9 

1 

0.5 

60-64 

183 

6 

3.3 

1 

0.5 

65-69 

147 

6 

4.1 

70-74 

94 

3 

3.2 

75-79 

38 

1 

2.6 

i 

2.6 

80  and  over 

26 

1 
36 

3.8 
3.1 

6 

Total 

1,179 

0.5 

Mortality  Experience,  Publicans  Only,  1846-1876 

1846-1876 123  2  1.6  |  1 

Mortality  Experience,  1879-1884 
1879-1884 1,300  42  3.2  |  10 


0.8 


0.8 


Source:  Tables  of  the  Mortality  Experience  of  The  British  Empire  Mutual  Life  As- 
surance Company  from  1847  to  1884. 

Table  42 

Mortality  Experience  of  The  Clergy  Mutual  Assurance  Society 

Mortality  from  Cancer,  by  Age,  1829-1887 

Deaths  Deaths 

from  All  from  Cancer 

Ages  Causes  Cancer  Per  Cent. 

Under  20 1 

20-29 45 

30-39 164  4  2.4 

40-49 272  17  6.3 

60-59 478  25  5.2 

60-69 562  33  5.9 

70-79 444  21  4.7 

80-89 147  2  1.4 

90  and  over 6 

Total 2,119  102  4.8 

Source :  Report  on  the  Mortality  Experience  of  The  Clergy  Mutual  Assurance  Society, 
from  1829  to  1887.    London,  1891. 

Note:  During  this  same  period  there  were  six  deaths  from  tumor  in  the  experience  of 
The  Clergy  Mutual  Assurance  Society,  2,  or  0.7,  at  ages  40-49;  1,  or  0.2,  at  ages  50-59;  1,  or 
0.2,  at  ages  60-69;  and  2,  or  0.5,  at  ages  70-79. 


364 


APPENDIX  D 

Table  43 

Mortality  Experience  of  The  Clergy  Mutual  Assurance  Society 

Mortality  of  Persons  Assured  as  "Unhealthy  Lives,"  1829-1887 


Ages 
Under  20. . . 

20-29 

30-39 

40-49 

50-59 

60-«9 

70-79 

80-89 

90  and  over. 

Total. . . . 


Deaths 

Deaths 

from  All 

from 

Cancer 

Causes 

Cancer 

Per  Cent 

i 

4 

11 

30 

2 

6.7 

14 

10 

1 

71 


Source:     Report  on   the   Mortality  Experience  of   The  Clergy  Mutual    Assurance 
Society  from  1829  to  1887.     London,  1891. 

Table  44 

Mortality  Experience  of  The  Equitable  Society,  London,  Eng. 

Cancer  Mortality,  1801-1832 


Deaths 

Deaths 

from  All 

from 

Cancer 

Ages 

Causes 

Cancer 

Per  Cent. 

10-19 

12 

20-29 

67 

30-39 

266 

2 

0.8 

40-49 

544 

5 

0.9 

50-59 

883 

14 

1.6 

60-69 

1,173 

15 

1.3 

70-79 

856 

4 

0.5 

80  and  over. . 

294 

3 
43 

1.0 

Total 

4,095 

1.1 

Source:  Tables  showing  the  total  num- 
ber of  persons  assured  in  The  Equitable 
Society  from  its  commencement  in  Septem- 
ber, 1762,  to  January  1, 1829,  and  a  supple- 
ment showing  the  mortality  of  the  Society 
for  the  years  1829  to  1832.     London,  1834. 


365 


APPENDIX  D 

Table  45 

Mortality  Experience  of  The  Gresham  Life  Assurance  Society 

Mortality  from  Cancer  and  Tumor,  by  Age 

Up  to  July  15,  1866 


Ages 
Under  20     

Deaths 
from  All 
Causes 

10 

Cancer 

Deaths 
from 
Cancer 

i 

3 
.6 
7 
3 
1 

21 

Cancer 
Per  Cent. 

1.4 
1.1 
2.3 
3.1 
2.8 
1.9 

2.1 

Deaths 
from  All 
Causes 

10 

73 
268 
263 
225 
107 

54 

TuMOK 

Deaths 

from 

Tumor 

i 

1 
1 

1 

4 

Tumor 
Per  Cent. 

20-29 

30-39 

40-49 

50-59  

73 
268 
263 

225 

0.4 
0.4 
0.4 

60-69 

107 

0.9 

70-79 

54 

Total 

1,000 

1,000 

0.4 

Source:     Gresham  Life  Assurance  Society,  Tl?e  Causes  of  Death,  tabulated  by  A.  H. 
Smee,  1868. 

Table  46 

Mortality  Experience  of  The  Metropolitan  Life  Assurance  Society,  England 

Mortality  from  Cancer  and  Tumor,  by  Age 

1835-1864 


Cancer 

Tumor 

Deaths 

Deaths 

Deaths 

from  All 

from 

Cancer 

from 

Tumor 

Ages 

Causes 

Cancer 

Per  Cent, 

Tumor 

Per  Cent. 

Under  20 

2 

•• 

i 

20-29 

22 

4.5 

30-39 

77 

i 

1.3 

40-49 

147 

2 

1.4 

50-59 

176 

3 

1.7 

i 

0.6 

60-69 

173 

5 

2.9 

70-79 

60 

5 

8.3 

80  and  over 

14 

Total 

671 

16 

2.4 

2 

0.3 

Source:     Metropolitan  Life  Assurance  Society,  Mortality  Experience  from  1835  to 
1864. 


366 


APPENDIX  D 

Table  47 

Mortality  Experience  of  The  Prudential  Assurance  Company,  London,  Eng. 

Mortality  from  Cancer,  by  Age  and  Sex 

1867-1870 


MALES 

FEMALES 

Deaths 

Deaths 

Deaths 

Deaths 

from  All 

from 

Cancer 

from  All 

from 

Cancer 

Ages 

Causes 

Cancer 

Per  Cent. 

Causes 

Cancer 

Per  Cent. 

Under  5 

7,568 

6 

0.08 

6,941 

8 

0.12 

&-9 

1,405 

2 

0.14 

1,327 

1 

0.08 

10-14 

687 

1 

0.15 

620 

15-S24 

1,392 

2 

0.14 

1,445 

4 

0.28 

25-34 

760 

6 

0.79 

981 

6 

0.61 

35-54 

2,290 

39 

1.70 

2,312 

166 

7.18 

55  and  over 

3,297 

82 
138 

2.49 
0.79 

4,147 

167 
352 

4.03 

Total 

17,399 

17,773 

1.98 

Source:     Mortality  Experience  of  The  Prudential  Assurance  Company  in  the  Indus- 
trial Branch  for  the  years  1867  to  1870.     London,  1871. 

Table  48 

Mortality  Experience  of  The  Prudential  Assurance  Company,  London,  Eng. 

Mortality  from  Tumor,  by  Age  and  Sex 

1867-1870 


IMALES 

FE^Ly^ES 

Deaths 

Deaths 

Deaths 

Deaths 

f 'om  All 

from 

Tumor 

from  All 

from 

Tumor 

Ages 

Causes 

Tumor 

Per  Cent. 

Causes 

Tumor 

Per  Cent. 

UnderS 

7,568 

,    , 

6,941 

1 

0.01 

5-9 

1,405 

1,327 

4 

0.30 

10-14 

687 

i 

0.14 

620 

15-24 

1,392 

1 

0.07 

1,445 

2 

0.14 

25-34 

760 

1 

0.13 

981 

1 

0.10 

35-54 

2,290 

5 

0.22 

2,312 

21 

0.91 

55  and  over 

3,297 

8 
16 

0.24 
0.09 

4,147 

18 
47 

0.43 

Total 

17,399 

17,773 

0.26 

Source:     Mortality  Experience  of  The  Prudential  Assurance  Company  in  the  Indus- 
trial B  ranch  for  the  years  1867  to  1870.     London,  1871 . 


367 


APPENDIX  D 

Table  49 

Mortality  Experience  of  The  Prudential  Assurance  Company,  London,  Eng. 

Mortality  from  Cancer,  by  Organs  and  Parts,  according  to  Age 

1867-1870 


MALES 


Organ  or  Part 

Head,  face,  mouth,  tongue,  eyes  and  ears . 

Breast 

Stomach 

Liver 

Rectum 

Not  defined 


All  organs 138 


Head,  face,  mouth,  tongue,  eyes  and  ears . 

Breast 

Stomach 

Liver 

Rectum 

Not  defined 


All  organs . 


Head,  face,  mouth,  tongue,  eyes  and  ears . 

Breast 

Stomach 

Liver 

Rectum 

Not  defined 


All  Ages 

Undeh  is 

Deaths 

from 
Cancer 

Per  Cent. 

Deaths 

from 
Cancer 

Per  Cent 

30 

21.7 

4 

44.4 

1 

0.7 

30 

21.7 

,   , 

24 

17.4 

8 

5.8 

45 

32.6 

5 

55.Q 

138 

100.0 

9 

100.0 

15-24 

25- 

-34 

1 

16.7 

i 

16.7 

2 

33.3 

k 

100.6 

'2 

33.3 

2 

100.0 

6 

100.0 

35-54 

55  AND 

Over 

7 

17.9 

18 

22.0 

1 

1.2 

6 

15.4 

23 

28.0 

10 

25.6 

12 

14.6 

3 

7.7 

5 

6.1 

13 

33.3 

23 

28.0 

39 

100.0 

82 

100.0 

All  organs 

Source:     Mortality  Experience  of  The  Prudential  Assurance  Company  in  the  Indus- 
rial  Branch  for  the  years  1867  to  1870.     London,  1871. 


APPENDIX  D 

Table  50 

Mortality  Experience  of  The  Prudential  Assurance  Company,  London,  Eng. 

Mortality  from  Cancer,  by  Organs  and  Parts,  according  to  Age 

1867-1870 


FEMALES 


All  Ages 


Organ  or  Part 


Deaths 

from 

Cancer 


Head,  face,  mouth,  tongue,  eyes  and  ears 24 

Breast 55 

Stomach 39 

Liver 25 

Rectum 5 

Kidneys  and  bladder 2 

Uterus 127 

Heart 1 

Leg 1 

Notdefined 73 


All  organs 352 


Head,  face,  mouth,  tongue,  eyes  and  ears . 

Breast 

Stomach 

Liver 

Rectum 

Kidneys  and  bladder 

Uterus 

Heart 

Leg 

Not  defined 


All  organs . 


Head,  face,  mouth,  tongue,  eyes  and  ears . 

Breast 

Stomach 

Liver 

Rectum 

Kidneys  and  bladder 

Uterus 

Heart 

Leg 

Not  defined 


20 
9 

11 
3 
1 

84 


32 


Per  Cent. 

6.8 

15.6 

11.1 

7.1 

1.4 

0.6 

36.1 

0.3 

0.3 

20.7 

100.0 


15-24 
1  25.0 


50.0 


25.0 
100.0 


3.6 
12.0 
5.4 
6.6 
1.8 
0.6 
50.6 


19.3 


100.0 


Undeb  15 


Deaths 

from 

Cancer 


Per  Cent. 


1  11.1 

9  100.0 

25-34 

2  33.3 
1  16.7 

1  16.7 

2  33.3 


6  100.0 

55  AND  OVEB 


9 
33 

27 

13 
2 
1 

41 
1 
1 

39 

167 


5.4 

19.8 

16.2 

7.8 

1.2 

0.6 

24.5 

0.6 

0.6 

23.3 

100.0 


All  Organs 166 

Source:     Mortality  Experience  of  The  Prudential  Assurance  Company  in  the  Indus- 
trial Branch  for  the  years  1867  to  1870.     London,  1871. 


369 


APPENDIX  D 

Table  51 

Mortality  Experience  of  The  Scottish  Amicable  Life  Assurance  Society 

Mortality  from  Cancer,  by  Age 

1826-1860 


Deaths 

Rate  per 

Lives  at 

from 

100,000 

Ages 

Eisk 

Cancer 

Lives 

Under  25 .  .  . 

.     2,349 

25-34 

.   14,665 

35-44 

.    19,330 

O 

25.9 

45-54 

.    12,401 

7 

56.4 

55-64 

.     5,682 

1 

17.6 

65  and  over.. 

.      1,873 

1 
14 

53.4 

Total .... 

.   56,300 

24.9 

Source:  Medical  Statistics  of  Life  As- 
surance: Being  an  inquiry  into  the  causes 
of  death  among  the  members  of  The  Scot- 
tish Amicable  Life  Assurance  Society  from 
1826  till  1860.     Glasgow,  1862. 


Table  52 

Mortality  Experience  of  The  Scottish  Amicable  Life  Assurance  Society 

Mortality'  from  Cancer,  by  Age  and  Sex,  Non-hazardous  Occupations 

1826-1860 


MALES 

FEMALES 

Ages 

Deaths 
from  AU 
Causes 

Deaths 
from 
Cancer 

Cancer 
Per  Cent. 

Deaths 
from  All 
Causes 

Deaths 
from 
Cancer 

Cancer 
Per  Cent. 

Under  25 

15 

1 

9 

25-34 

90 

35-44 

170 

4 

2.4 

19 

1 

5.3 

45—54 

147 

3.4 

8 

2 

25.0 

55-64 

114 

0.9 

10 

65-74 

79 

1.3 

13 
3 

75  and  over 

17 

Total 

632 

11 

1.7 

63 

3 

5.3 

Source:  Medical  Statistics  of  Life  Assurance:  Being  an  inquiry  into  the  causes  of 
death  among  the  members  of  The  Scottish  Amicable  Life  Assurance  Society  from  1826  till 
1860.     Glasgow,  1862. 


370 


APPENDIX  D 

Table  53 
Mortality  Experience  of  The  Scottish  Amicable  Life  Assurance  Society 
Mortality  from  Tumor,  by  Age  and  Sex,  Non-Hazardous  Occupations 

1826-1860 


MALES 

FEMALES 

Agea 

No.  of 
Deaths 

Per 

Cent. 

No.  of                       Per 
Deaths                    Cent, 

Under  25               

0.7 

0.9 

55-34 

35-44 

45-54 

55-64 

65-74 

75  and  over 

........       i 

1 

Total 

2 

0.3 

Source:  Medical  Statistics  of  Life  Assurance:  Being  an  inquiry  into  the  causes  of 
death  among  the  members  of  The  Scottish  Amicable  Life  Assurance  Society  from  1826  till 
1860.     Glasgow,  1862. 

Table  54 

Mortality  Experience  of  The  Scottish  Amicable  Life  Assurance  Society 

Mortality  from  Cancer,  by  Age,  Hazardous  Occupations 

1826-1860 


Ages 
Under 25..  . 

25-34 

35-44 

45-54 

55-64 

65-74 

75  and  over 

Total.  . 


Exclusive  op  West  Indies 


Deaths 
from  All 
Causes 

1 

7 
10 
11 
10 


47 


Deaths 

from  Cancer 

Cancer      Per  Cent. 


West  Indies 

Deaths  Deaths 

from  All  from  Cancer 

Causes  Cancer     Per  Cent. 


6 

9 

12 

4 


31 


Source:  Medical  Statistics  of  Life  Assurance:  Being  an  inquiry  into  the  causes  of 
death  among  the  members  of  The  Scottish  Amicable  Life  Assurance  Society  from  1826  till 
1860.     Glasgow,  1862. 


371 


APPENDIX  D 

Table  55 
Mortality  Experience  of  The  Scottish  Union  and  National  Insurance  Com- 
pany, 1912 

Mortality  from  Cancer,  by  Organs  and  Parts 

Deaths 

from  Cancer 

Organ  or  Part                                                                                                               Cancer  Per  Cent. 

Mouth  and  throat 1  0.2 

Larynx 1  0.2 

Lung 5  1.1 

Mediastinum 5  1.1 

Stomach 4  0.9 

Pancreas 1  0.2 

Liver 1  0.2 

Intestines 16  3.5 

Peritoneum 1  0.2 

Bladder 2  0.4 

Prostate  Gland 3  0.7 

Vesicula  seminalis 1  0.2 

Uterus 1  0.2 

Bone 1  0.2 

Not  stated 1  0.2 

All  organs 44  9.5 

Source:     Analysis  of  Deaths  in  The  Scottish  Union  and  National  Insurance  Company, 
1912. 

Note:   All  the  above  deaths  are  males  except  the  one  death  from  cancer  of  uterus. 

Table  56 
Mortality  Experience  of  The  Scottish  Widows'  Fund  and  Life  Assurance 

Society 

Mortality  from  Cancer  and  Tumor,  by  Age 

1815-1845 


Cancer 

TUMOB 

Deaths 

Deaths 

Deaths 

from  All 

from 

Cancer 

from 

Tumor 

Ages 

Causes 

Cancer 

Per  Cent. 

Tumor 

Per  Cent. 

20-30 

28 

30-40 

109 

2 

1.8 

40-50 

143 

2 

1.4 

50-60 

143 

2 

1.4 

2 

1.4 

60-70 

123 

2 

1.6 

70-80 

57 

1 

1.8 

AboveSO 

12 

Unknown 

27 

Total 

642 

6 

0.9 

5 

0.8 

Source:    Observations  on  the  Mortality  of  The  Scottish  Widows'  Fund  and  Life 
Assurance  Society  from  1815  to  1845.     Edinburgh,  1847. 


372 


APPENDIX  D 

Table  57 
Mortality  Experience  of  The  Scottish  Widows'  Fund  and  Life  Assurance 

Society 

Mortality  from  Cancer  and  Tumor,  by  Age 

1846-1852 


Cancer 

Tumor 

Deaths 

Deaths 

Deaths 

from  All 

from 

Cancer 

from 

Tumor 

Ages 

Causes 

Cancer 

Per  Cent. 

Tumor 

Per  Cent. 

20-30 

24 

1 

4.2 

30-40 

83 

40-50 

144 

i 

0.7 

50-60 

178 

2 

i.i 

2 

1.1 

60-70 

151 

2 

1.3 

2 

1.3 

70-80 

82 

2 

2.4 

Above  80 

28 

Total 

690 

5 

0.7 

7 

1.0 

Source:  Medical  Statistics  of  Life  Assurance,  Observations  on  the  Causes  of  Death 
among  the  Assured  of  The  Scottish  Widows'  Fund  and  Life  Assurance  Society  from  1846 
to  1852.     Edinburgh,  1853. 

Table  58 
Mortality  Experience  of  The  Scottish  Widovi's'  Fund  and  Life  Assurance 

Society 
Mortality  from  Cancer  and  Tumor,  by  Age 

1853-1859 


Cancer 

Tumor 

Deaths 

Deaths 

Deaths 

from  All 

from 

Cancer 

from 

Tumor 

Ages 

Causes 

Cancer 

Per  Cent. 

Tumor 

Per  Cent. 

20-30. 

33 

,  , 

30-40. 

106 

i 

0.9 

,  , 

40-50. 

167 

4 

2.4 

50-60. 

245 

5 

2.0 

2 

0.8 

60-70. 

242 

15 

6.2 

1 

0.4 

70-80. 

150 

2 

1.3 

Above 

80 

32 

1 

3.1 

Total 

975 

28 

2.9 

3 

0.3 

Source:     On  the  Causes  of  Death  in  The  Scottish  Widows'  Fund  and  Life  Assurance 
Society,  1853-1859.     Edinburgh,  1860. 


373 


APPENDIX  D 

Table  59 

Mortality  Experience  of  The  Scottish  Widows'  Fund 

and  Life  Assurance  Society 

Proportionate  Mortality  from  Cancer,  by  Age 

1874-1880  Compared  with  1888-1894 


Ages 

25-35 

35-45 

45—55 

55-65 

1874-1880 

Cancer 
Per  Cent. 

1.64 

8.20 
12.30 
33.60 
36.88 

1888-1894 

Cancer 
Per  Cent 

2.78 

8.73 
21.83 
31.75 
25.79 

9.12 

100.00 

Variations 
+  1.14 
+0.53 
+9.53 
-1.85 

-11.09 

75  and  over 

7.38 

-1.74 

Total 

100.00 

Source:  The  Causes  of  Death  among  the  Assured  in  The 
Scottish  Widows'  Fund  and  Life  Assurance  Society  from 
1874  to  1894,  inclusive.     Edinburgh,  1902. 

Table  60 
Mortality  Experience  of  The  Scottish  Widows'  Fund 

and  Life  Assurance  Society 

Annual  Mortality  from  Cancer  among  100,000  Males 

Living  at  Each  "Group  of  Ages,"  1874-1894 


Ages 

1874-1880 

Rate  Per 

100,000 

Lives 

1881-1887 

Rate  Per 

100,000 

Lives 

1888-1894 

Rate  Per 

100,000 

Lives 

25-34 

35-44 

45-54 

55-64 

65-74 

5.1 

21.9 

47.2 

207.8 

469.8 

4.2 

23.7 

73.4 

258.9 

336.7 

422.2 

14.9 

29.5 

90.2 

245.3 

451.8 

75  and  over 

346.8 

483.3 

Total 

78.6 

81.9 

104.2 

Source:  The  Causes  of  Death  among  the  Assured  in  The 
Scottish  Widows'  Fund  and  Life  Assurance  Society  from 
1874  to  1894,  inclusive.     Edinburgh,  1902. 


374 


APPENDIX  D 

Table  61 
Mortality  Experience  of  The  Scottish  Widows'  Fund  and  Life  Assurance 

Society 

Mortality  from  Cancer  of  Internal  and  External  Organs,  Males 

1874-1894 


Intern 

AL  CbGANS 

1874-1880 

1881-1887 

1888-1894 

1874-1894 

Organ  or  Part 

No. 

% 

No.          % 

No. 

% 

No. 

% 

Stomach 

28 

24.56 

33     21.85 

50 

20.24 

Ill 

21.68 

Liver 

23 

20.18 

28     18.55 

42 

17.00 

93 

18.17 

Bowel 

5 

4.39 

15       9.93 

23 

9.31 

43 

8.40 

Abdomen 

7 

6.14 

13       8.60 

14 

5.67 

34 

6.64 

Bladder 

5 

4.39 

3       1.99 

8 

3.24 

16 

3.13 

Mediastinum 

1 

0.88 

8       5.30 

4 

1.62 

13 

2.54 

Qilsophagus 

2 

1.75 

2       1.33 

8 

3.24 

12 

2.34 

Prostate 

3 

2.63 

2       1.33 

3 

1.21 

8 

1.56 

Kidneys 

2 

1.75 

1       0.66 

4 

1.62 

7 

1.37 

Pancreas 

3 

2.63 

3 

1.21 

6 

1.17 

Lung 

2 

1.75 

i       0.66 

2 

0.81 

5 

0.98 

Brain 

1 

0.41 

1 

0.19 

Spinal  cord 

1       0.66 

1 

0.19 

All  organs 

81 

71.05 

EXTEB> 

107     70.86 
rAL  Organs 

162 

65.58 

350 

68.36 

Rectum 

12 

10.52 

26     17.22 

30 

12.14 

68 

13.28 

Tongue 

8 

7.02 

2       1.33 

13 

5.26 

23 

4.49 

Tissues 

4 

3.51 

5       3.31 

8 

3.24 

17 

3.32 

Throat 

3 

2.63 

1       0.66 

5 

2.02 

9 

1.76 

Larynx 

1 

0.88 

1       0.66 

6 

2.43 

8 

1.56 

Bones 

1       0.66 

6 

2.43 

7 

1.37 

Mouth 

1 

0.88 

2       1.33 

2 

0.81 

5 

0.96 

Parotid 

3 

2.63 

1       0.66 

1 

0.41 

5 

0.98 

Glands.... 

1       0.66 

4 

1.62 

5 

0.98 

Penis 

1 

0.88 

2       1.33 

1 

0.41 

4 

0.78 

Jaw 

4 

1.62 

4 

0.78 

Testes 

2 

0.81 

2 

0.39 

Eye 

1       0.66 

1 

0.41 

2 

0.39 

Lip 

2 

0.81 

2 

0.39 

Skin 

i       0.66 

1 

0.19 

All  organs 

33 

28.95 

44     29.14 

85 

34.42 

162 

31.64 

Source:     The  Causes  of  Death  among  the  Assured  in  The  Scottish  Widows'  Fund  and 
Life  Assurance  Society  from  1874  to  1894,  inclusive.     Edinburgh,  1902. 


375 


APPENDIX  D 

Table  62 
Mortality  Experience  of  The  Scottish  Widows'  Fund  and  Life  Assurance 

Society 
Annual  Mortality  from  Cancer  of  Internal  and  External*  Organs  among 
100,000  Males  Living  at  All  Ages,  1874-1894 


External  Organs 

Rate  per 
100,000 

Lives 

Ratio 

21.2 

100.0 

21.8 

102.8 

35.2 

166.0 

Internal  Organs 

Rate  per 
Period  100,000  Ratio 

Lives 

1874-1880 52.2  100.0 

1881-1887 53.1  101.7 

1888-1894 67.0  128.4 

Source:    The  Causes  of  Death  among  the  Assured  in  The  Scottish  Widows'  Fund  and 
Life  Assurance  Society  from  1874  to  1894,  inclusive.    Edinburgh,  1902. 
*Rectum  is  included  in  external  organs. 

Table  63 

Mortality  Experience  of  British  and  German  Life  Insurance  Companies 

Proportionate  Mortality  from  Cancer 

Up  to  1860 

Cancer 
Per  Cent. 

Gotha  Life  Insurance 2.83 

Scottish  Amicable 1.81 

Scottish  Widows'  Fund 1.69 

Standard 2.07 

North  British 1.91 

London  Equitable 1.05 

England  and  Wales,  1848-1854 2.61 

Source:     Aus  der  Praxis  der  Gothaer  Lebensversicherungs-Bank.     Jena,  1902. 

Table  64 

Mortality  Experience  of  German  Life  Insurance  Companies 

Mortality  from  Cancer,  1899-1912 

Deaths  Deaths 

Number  of  from  All 

Year  Companies  Causes 

1899 4  5,530 

1900 '. 5  6,607 

1901 7  8,532 

1902 7  8,543 

1903 6  5,627 

1904 8  6,393 

1905 9  7,844 

1906 10  7,587 

1907 11  7,765 

1908 11  8,368 

1909 11  8,473 

1910 12  10,378 

1911 12  10,892 

1912 11  9.439 

1899-1912 111,978  12,190  10.9 

Source:     Annual  Reports  of  the  several  companies. 

376 


from 

Cancer 

Cancer 

Per  Cent 

645 

11.7 

735 

11.1 

933 

10.9 

1,006 

11.8 

608 

10.8 

696 

10.9 

837 

10.7 

883 

11.6 

865 

11.1 

815 

9.7 

897 

10.6 

1,106 

10.7 

1,165 

10.7 

999 

10.6 

APPENDIX  D 

Table  65 

Mortality  Experience  of  the  Life  Insurance  Company  of  the  "Deutscher 

Kriegerbund"  ( German  Veteran  Society),  Berlin,  Germany 

Mortality  from  Cancer 

1908-1911 

Deaths  Deaths 

from  All  from  Cancer 

Year  Causes  Cancer  Per  Cent. 

1908 1,439  123  8.5 

1909 1,579  156  9.9 

1910 1,671  152  9.1 

1911 1,824  194  10.6 

1908-1911 6,513  625  9.6 

Mortality  from  Cancer,  by  Organs  and  Parts 
1908-1911 

Deaths 
from  Cancer 

Organ  Cancer  Per  Cent. 

Stomach,  liver  and  abdomen    333  5.1 

Other  organs 292  4.5 

AU  organs 625  9.6 

Source:     Annual  Reports  of  Die  Lebensversichenmgs-Anstalt  und   Sterbekasse  des 
Deutschen  Kriegerbundes,  Berlin. 


Table  66 

Mortality  Experience  of  the 

German  Life  Insurance  Company 

Potsdam,  Germany 

Mortality  from  Cancer,  by  Age 

1907-1912 

Deaths  Deaths 

from  All  from  Cancer 

Ages  Causes  Cancer      Per  Cent. 

30  and  under.  80  3  3.8 

31-40 354  17  4.8 

41-50 633  74  11.7 

51-60 914  125  13.7 

61-70 1,181  199  16.9 

71  and  over...  930  92  9.9 

Total 4,092  510  12.5 

Source:  Annual  Reports  of  Die  Deutsche 
Lebensversicherung,  Potsdam. 


Table  67 
Mortality  Experience  of  the  Bremen- 
Hanoveranian  Life  Insurance  Com- 
pany' "Freia,"  Hanover,  Germany 
Mortality  from  Cancer,  by  Age 
1907-1913 


Ages 

Deaths 

from  All 

Causes 

Deaths 
from 
Cancer 

Cancer 
Per  Cent 

30  and  under . 

158 

2 

1.3 

31-60 

2,112 

183 

8.7 

61-70 

926 

140 

15.1 

71  and  over.. . 

785 

62 

7.9 

Total. 


3,981 


387 


9.7 


Source:  Annual  Reports  of  "Freia," 
Bremen-Hannoversche  Lebensversicher- 
ungs-Bank,  Hanover. 


377 


APPEXDIX  D 

Table  68 
Ordinary  Mortality  Experience  of  the  "Friedrich  Wilhelm"  Life  Insurance 

Company,  Germany 
Mortality  from  Cancer,  1885-1913 


Year 

Deaths 
from  All 
Causes 

Deaths 

from 
Cancer 

Cancer 
Per  Cent. 

1885 

426 

36 

8.5 

1886 

434 

35 

8.1 

1887 

497 

59 

11.9 

1888 

492 

54 

11.0 

1889 

508 

73 

14.4 

1890 

507 

50 

9.9 

1891 

329 

33 

10.0 

1892 

338 

27 

8.0 

1893 

385 

31 

8.1 

1894 

355 

43 
441 

12.1 

1885-1894 

4,271 

10.3 

1895 

382 

41 

10.7 

1896 

368 

39 

10.6 

1897 

410 

48 

11.7 

1898 

395 

42 

10.6 

1899 

463 

54 

11.7 

1900 

431 

49 

11.4 

1901 

508 

60 

11.8 

1902 

533 

56 

10.5 

1903 

556 

72 

12.9 

1904 

540 

59 
520 

10.9 

1895-1904 

4,586 

11.3 

1905 

516 

55 

10.7 

1906 

567 

65 

11.5 

1907 

604 

69 

11.4 

1908 

640 

53 

8.3 

1909 

666 

69 

10.4 

1910 

675 

71 

10.5 

1911 

750 

71 

9.5 

1912 

862 

88 

10.2 

1913 

848 

93 

634 

11.0 

1905-1913  

6,128 

10.3 

Source:  Zeitschrift  fiir  Kxebsforschung.Yol.  III.  Friedrich 
Wilhelm  Lebensversicherungs-Actiengesellschaft  in  Berlin. 
Geschaftsbericht. 


378 


APPENDIX  D 

Table  69 
Ordinary  Mortality  Experience  of  the  "Friedrich  Wilhelm"  Life  Insurance 

Company,  Germany 
Mortality  from  Cancer,  by  Organs  and  Parts,  according  to  Sex 

1885-1899 


MALES 

Deaths 

from  Per 

Organ  or  Part                                                   Cancer  Cent. 

Lips 

Nose 

Tongue 10  2.1 

(Esophagus 48  9.9 

Stomach 216  44.6 

Intestines 59  12.2 

Liver 65  13.4 

Larynx 16  3.3 

Lungs 4  0.8 

Breast 3  0.6 

Bladder." 7  1.5 

Prostate 3  0.6 

Kidneys 3  0.6 

Uterus 

Bones 10  2.1 

Other  organs 40  8.3 

All  organs 484  100.0 

Source:    Zeitschrift  fiir  Krebsforschung,  Vol.  III. 


FEMALES 

Deaths 

from 

Per 

Cancer 

Cent. 

3 

1.6 

56 

30.9 

10 

6.5 

24 

13.3 

0.6 

"  * 

4.4 

0.6 

'2 

i.i 

63 

34.8 

1 

0.6 

12 

6.6 

181 


100.0 


Life  Insurance 


Table  70 
Ordinary  Mortality  Experience  of  the  "Friedrich  Wilhelm' 

Company,  Germany 
Mortality  from  Cancer,  by  Age  and  Sex 

1885-1899 


MALES 

FEMALES 

Ages 

Deaths 

from 
Cancer 

Per  Cent. 

Deaths 
from 
Cancer 

Per  Cent 

20-29 

4 

0.8 

1 

0.6 

30-39 

24 

5.0 

11 

6.1 

40-49 

104 

21.5 

46 

25.4 

50-59 

170 

35.1 

69 

38.1 

60-69 

143 

29.5 

38 

21.0 

70-79 

38 

7.9 

16 

8.8 

80  and  over 

1 

0.2 

Total 

484 

100.0 

181 

100.0 

379 


APPENDIX  D 

Table  71 
Industrial  Mortality  Experience  of  the  "Friedrich  Wilhelm"  Life  Insurance 

Company,  Germany 

Mortality  from  Cancer,  by  Sex 

1885-1899 


MALES 

Deaths  Deaths 

from  All  from  Cancer 

Year                                                 Causes  Cancer  Per  Cent. 

1885 326  12  3.7 

1886 520  23  4.4 

1887 553  22  4.0 

1888 431  38  8.8 

1889 833  55  6.6 

1885-1889 2,663  150  5.6 

1890 1,062  64  6.0 

1891 1,309  100  7.6 

1892 1,441  110  7.6 

1893 1,826  113  6.2 

1894 2,180  182  8.3 

1890-1894 7,818  569  7.3 

1895 2,721  229  8.4 

1896 3,287  299  9.1 

1897 3,930  349  8.9 

1898 4,712  409  8.7 

1899 5,952  475  8.0 

1895-1899 20,602  1,761  8.5 

Source:     Zeitschrift  fiir  Krebsforschung,  Vol.  III. 


FEMALES 

Deaths 

Deaths 

from  All 

from 

Cancer 

Causes 

Cancer 

Per  Cent 

325 

37 

11.4 

400 

38 

9.5 

491 

58 

11.8 

438 

50 

11.4 

802 

98 

12.2 

2,456 

281 

11.4 

980 

111 

11.3 

1,307 

174 

13.3 

1,603 

207 

12.9 

1,864 

210 

11.3 

2,192 

289 

13.2 

7,946 

991 

12.5 

2,644 

344 

13.0 

3,285 

434 

13.2 

3,770 

543 

14.4 

4,634 

624 

13.5 

5,827 

719 

12.3 

20,160        2.664 


13.2 


380 


APPENDIX  D 

Table  72 
Industrial  Mortality  Experience  of  the  "Friedrich  Wilhelm"  Life  Insurance 

Company,  Germany 
Mortality  from  Cancer,  by  Organs  and  Parts,  according  to  Sex 

1885-1899 


MALES 

Deaths 

from  Per 

Organ  or  Part                                                   Cancer  Cent. 

Lips 5  0.2 

Nose ; 2  0.1 

Tongue 23  0.9 

(Esophagus 267  10.8 

Stomach 1,580  63.7 

Intestines 120  4.8 

Liver 222  9.0 

Larynx 27  1.1 

Lungs 12  0.5 

Breast 7  0.3 

Bladder 36  1.4 

Prostate 3  0.1 

Kidneys 4  0.2 

Uterus 

Bones 15  0.6 

Other  organs 157  6.3 

Allorgans 2,480  100.0 

Source:     Zeitschrift  fiir  Krebsforschung,  Vol.  III. 


FEMALES 

Deaths 

from 

Per 

Cancer 

Cent. 

1 

0.0 

2 

0.1 

2 

0.1 

68 

1.7 

1,503 

38.2 

161 

4.1 

413 

10.5 

17 

0.4 

9 

0.2 

205 

5.2 

24 

0.6 

9 

0.2 

1,287 

32.7 

20 

0.5 

215 

5.5 

3,936 


100.0 


Table  73 
Industrial  Mortality  Experience  of  the  "Friedrich  Wilhelm"  Life  Insurance 

Company,  Germany 
Mortality  from  Cancer,  by  Age  and  Sex 

1885-1899 


MALES 

Deaths 

from  Per 

Ages                                                              Cancer  Cent. 

20-29 6  0.2 

30-39 70  2.8 

40-49 390  15.7 

50-59 1,140  46.0 

60-69 821  33.1 

70-79 62  2.1 

80  and  over 1  0.1 

Total 2,480  100.0 

Source:    Zeitschrift  fiir  Krebsforschung,  Vol.  III. 


FEMALES 

Deaths 

from 

Per 

Cancer 

Cent 

15 

0.4 

166 

4.2 

746 

18.9 

1,755 

44.6 

1,154 

29.3 

98 

2.5 

2 

0.1 

3,936 


100.0 


38] 


APPENDIX  D 


Table  74 
Mortality  Experience  of  the  German  Life  Insurance  Company,  Liibeck 
Mortality  from  Cancer,  by  Sex 
1906-1913 


MALES 

FEMALES 

Deaths 

Deaths 

Deaths 

Deaths 

from  All 

from 

Cancer 

from  All 

from 

Cancer 

Year 

Causes 

Cancer 

Per  Cent. 

Causes 

Cancer 

Per  Cent. 

1906 

790 

97 

12.3 

79 

12 

15.2 

1907 

770 

84 

10.9 

88 

7 

8.0 

1908 

768 

72 

9.4 

101 

13- 

12.9 

1909 

755 

87 

11.5 

89 

12 

13.5 

1910 

726 

93 

12.8 

82 

10 

12.2 

1911 

728 

91 

12.5 

83 

11 

13.3 

1912 

768 

79 

10.3 

91 

16 

17.6 

1913 

724 

94 

13.0 

87 

13 

14.9 

1906-1913 

6,029 

697 

11.6 

700 

94 

13.4 

Table  75 

Mortality  Experience  of  the  "Germania"  Life  Insurance  Company,  Germany 

Mortality  from  Cancer,  by  Age  and  Sex 

1857-1894 


MALES 


Ages 


Number  of  Lives 

Exposed  to  Risk 

One  Year 


Under  26 41,661.5 

26-30                  178,126.0 

31-35 315,234.5 

36-40 361,870.5 

41-45 340,411.0 

46-50 284,106.5 

51-55 213,976.5 

56-60 141,419.5 

61-65 79,587.5 

66-70 37,493.5 

71  and  over 18,529.5 


Total 2,012,416.5 

FEMALES 

Under  26 29,502.5 

26-30 74,549.5 

31-35 109,396.0 

36-40 119,658.0 

41-45 115,751.5 

46-50 102,250.5 


51-55 

56-60 

Cl-65 

66-70 

71  and  over. 


81,023.5 
55,916.0 
33,335.0 
17,138.5 
10,638.0 


Deaths 
from  Cancer 
and  Tumor 

1 

11 

50 

120 

227 
399 
484 
498 
449 
297 
147 


2,683 

2 

13 

33 

83 

196 

245 

245 

235 

192 

95 

85 


Rate  per 
100,000 
Exposed 

2.4 

6.2 

15.9 

33.2 

66.7 

140.4 

226.2 

352.1 

564.2 

792.1 

793.3 

133.3 


6.8 

17.4 

30.2 

69.4 

169.3 

239.6 

302.4 

420.3 

576.0 

554.3 

799.0 


Total 749,159.0  1,424  190.1 

Source:     Untersuchimgen  iiber  die  Sterblichkeit  unter  den  Versicherten  der  "Ger- 
mania," Lebensversicherungs-Aktien-Gesellschaft  zu  Stettin.     Berlin,  1897. 


382 


APPENDIX  D 

Table  76 

Mortality  Experience  of  the  Gotha  Life  Insurance  Company,  Germany 

Mortality  from  Cancer  by  Age,  Males 

1829-1878 


Number  of 
Ages  Lives  Exposed 

to  Risk 

15-20 714.5 

21-25 7,174.0 

26-30 40,574.0 

31-35 97,948.5 

36-40 141,078.5 

41-45 156,854.0 

46-50 148,165.0 

51-55 128,034.5 

56-60 99,884.0 

61-65 69,231.0 

66-70 42,108.5 

71-75 21,253.5 

76-80 8,288.0 

81-85 2,339.5 

86-90 325.5 

Total 963,973.0 


Deaths 

from 
Cancer 

Rate  per 
100,000 
Exposed 

k 

4.9 

11 

11.2 

40 

28.4 

80 

51.0 

141 

95.2 

168 

131.2 

226 

226.3 

271 

391.4 

207 

491.6 

122 

574.0 

41 

494.7 

13 

555.7 

1,322 


137.1 


Source:     Aus  der  Praxis  der  Gothaer  Lebensversicherungsbank.     Jena,  1902. 

Table  77 

Mortality  Experience  of  the  Gotha  Life  Insurance  Company,  Germany 

Mortality  from  Cancer,  by  Age  and  Duration  of  Insurance,  Males 

1829-1896 


15-25 

26-30 

31-35 

36-40 

41-45 

46-50 

51-55 

56-60 

61-65 

66-70 

71-75 

76-80 

81-85 

86-90 

Total 

Source:     Aus  der  Praxis  der  Gothaer  Lebensversicherungsbank.     Jena,  1902. 


1st  to  5th 

6th  and 

Insurance  Years 

Si 

ibsequent  Years 

Deaths 

Deaths 

Deaths 

Deaths 

from  All 

from 

Cancer 

from  All 

from 

Cancer 

Causes 

Cancer 

Per  Cent. 

Causes 

Cancer 

Per  Cent 

127 

19 

403 

1 

0.2 

88 

,  , 

,  , 

767 

9 

1.2 

506 

8 

1.6 

867 

22 

2.5 

1,350 

58 

4.3 

755 

44 

5.8 

2,429 

135 

5.6 

599 

31 

5.2 

3,422 

274 

8.0 

495 

29 

5.9 

4,452 

397 

8.9 

382 

35 

9.2 

5,361 

537 

10.0 

157 

15 

9.6 

5,836 

634 

10.9 

29 

3 

10.3 

5,750 

541 

9.6 

1 

4,679 

385 

8.2 

3,082 

150 

4.9 

1,442 

53 

3.7 

189 

4.1 

382 

7 

1.8 

4,582 

38,798 

3,179 

8.2 

383 


26 


APPENDIX  D 

Table  78 

Mortality  Experience  of  the  Gotha  Life  Insurance  Company,  Germany 

Mortality  from  Cancer,  by  Age 

1903-1912 


1903-1907 

1908-1912 

Deaths 

Deaths 

Deaths 

Deaths 

from  All 

from 

Cancer 

from  All 

from 

Cancer 

Ages 

Causes 

Cancer 

Per  Cent. 

Causes 

Cancer 

Per  Cent. 

15-30 

142 

6 

4.2 

165 

6 

3.6 

31-35 

209 

6 

2.9 

247 

10 

4.0 

36-40 

344 

26 

7.6 

361 

22 

6.1 

41-45 

523 

51 

9.8 

525 

56 

10.7 

46-50 

741 

92 

12.4 

773 

92 

11.9 

51-55 

895 

143 

16.0 

1,031 

168 

16.3 

56-60 

1,175 

182 

15.5 

1,153 

190 

16.5 

61-65 

1,321 

206 

15.6 

1,330 

216 

16.2 

66-70 

1,445 

230 

15.9 

1,439 

236 

16.4 

71-75 

1,175 

145 

12.3 

1,359 

172 

12.7 

76-80 

967 

98 

10.1 

1,074 

94 

8.8 

81-85 

565 

28 

5.0 

635 

29 

4.6 

86-90 

201 

5 

2.5 
12.6 

235 

9 

3.8 

Total 

9,703 

1,218 

10,327 

1,300 

12.6 

Ages 
15-30. 
31-35. 
36-40. 
41-45. 
46-50. 
51-55. 
56-60. 
61-65. 
66-70. 
71-75. 
76-80. 
81-85. 
86-90. 


Deaths 
from  All 
Causes 

307 

456 

705 

1,048 

1,514 

1,926 

2,328 

2,651 

2,884 

2,534 

2,041 

1,200 

436 


1903-1912 
Deaths 
from 
Cancer 

12 

16 

48 
107 
184 
311 
372 
422 
466 
317 
192 

57 

14 


Cancer 
Per  Cent, 

3.9 

3.5 

6.8 

10.2 

12.2 

16.1 

16.0 

15.9 

16.2 

12.5 

9.4 

4.8 

3.2 


Total 20,030         2,518  12.6 

Source:    Original  data  furnished  by  the  Gothaer  Lebensversicherungsbank,  Gotha. 


384 


APPENDIX  D 

Table  79 

Mortality  Experience  of  the  Gotha  Life  Insurance  Company,  Germany 

Mortality  from  Cancer  among  Teachers 

1829-1890 


Number  of  Deaths 

Lives  Exposed  from 

to  Risk  Cancer 
School-teachers 

Ages  21-45 82,213.0  22 

46-60 54,770.5  93 

61-90 22,885.0  112 

All  ages 159,868.5  227 

High-school  Teachers 

Ages  26-45 32,247.0  13 

46-60 20,687.0  31 

61-90 9,014.5  39 

All  ages 61,948.5  83 

University  Professors 7,814.5  10 

Professors  of  Medicine 2,792.0  5 

Source:     Aus  der  Praxis  der  Gothaer  Lebensversicherungsbank.     Jena,  1902. 


Rate  per 
100,000 
Exposed 

26.8 
169.8 
489.4 
142.0 


40.3 
149.9 
432.6 
134.0 

128.0 

179.1 


Table  80 
Mortality  Experience  of  the  Karlsruhe  Life  Insurance  Company,  Germany 

Mortality  from  Cancer 
1910-1913 


Year 

Deaths 
from  All 
Causes 

Deaths 

from 
Cancer 

Cancer 
Per  Cent. 

1910 

1911 

1912 

1913 

.  . .     1,436 
.  .  .     1,554 
. . .     1,535 
. .  .     1,564 

169 
195 
230 
256 

11.8 

12.5 
15.0 
16.4 

1910-1913...     6.089 


850 


14.0 


Source:      Correspondence    from    Karls- 
ruher  Lebensversicherung,  Karlsruhe. 


385 


APPENDIX  D 

Table  81 

Mortality  Experience  of  the  Karlsruhe  Life  Insurance  Company,  Germany 

Mortality  from  Cancer,  by  Organs  and  Parts,  according  to  Age 

1910-1913 


Per  Cent. 
Under  71  and  All  of  All 

Organ  or  Part  30  31-40  41-50  51-60  61-70  Over  Ages         Organs 

Tongue 3  2  ..  3  8  0.9 

Larynx 3  6  5  2  16  1.9 

(Esophagus  and 

stomach 2            22  76  144  117  G8  399  46.9 

Intestines 10  21  60  51  25  167  19.7 

Liver                      ....               5  10  26  26  10  77  9.1 

Breast 2  4  2  ..  8  0.9 

Uterus 4  2  2  8  0.9 

Other  organs 1               8  25  54  49  30  167  19.7 

All  organs 3  45  140  300  252  110  850 

Per  cent,  of  all  ages.    0.4  5.3  16.5  35.3  29.6  12.9  ..  100.0 

Source:     Original  data  furnished  by  the  Karlsruher  Lebensversicherung,  Karlsruhe. 

Table  82 

Mortality  Experience  of  the  Karlsruhe  Life  Insurance  Company,  Germany 

Mortality  from  Cancer,  by  Organs  and  Parts 

1900-1905 


Deaths 

Organ  or  Part                             from  Per  Cent. 
Cancer 

Tongue 12  1.7 

Larynx 17  2.3 

CEsophagus  and  stomach 347  48.0 

Intestines 134  18.5 

Liver 93  12.9 

Breast 8  1.1 

Uterus 20  2.8 

Otherorgans 92  12.7 

All  organs 723  100.0 

Source:     Annual  Reports  of  Karlsruher  Lebensversicherung,  Karlsruhe. 


386 


APPENDIX  D 

Table  83 

Mortality  Experience  of  the  Karlsruhe  Life  Insurance  Company,  Germany 

Mortality  from  Cancer,  by  Age,  1900-1905 


Deaths  Deaths 

from  All  from  Cancer 

Ages                Causes  Cancer        Per  Cent. 

20  and  under.  5 

21-25 67  2  3.0 

26-30 223  2  0.9 

31-35 368  10  2.7 

36-40 569  26  4.6 

41-45 784  59  7.5 

46-50 915  109  11.9 

51-55 1,040  146  14.0 

56-60 1,008  155  15.4 

61-65 776  109  14.0 

66-70 537  60  11.2 

71-75 329  31  9.4 

76-80 127  12  9.4 

Above  80 42  2  4.8 

Total 6,790  723  10.6 

Source:     Annual  Reports  of  the  Karls- 
ruher  Lebensversicherung,  Karlsruhe. 


Table  84 

Mortality  Experience  of  the  Leipzig  Life  Insurance  Company,  Germany 

Mortality  from  Cancer,  by  Sex,  1893-1913 


MALES 

FEMALES 

Deaths 

Deaths 

Deaths 

Deaths 

from  All 

from 

Cancer 

from  All 

from 

Cancer 

Years 

Causes 

Cancer 

Per  Cent. 

Causes 

Cancer 

Per  Cent. 

1893 

752 

86 

11.4 

46 

5 

10.9 

1894 

743 

75 

10.1 

40 

5 

12.5 

1895 

785 

83 

10.6 

60 

7 

11.7 

1896 

829 

91 

11.0 

34 

5 

14.7 

1897 

797 

96 

12.0 

38 

4 

10.5 

1898 

847 

94 

11.1 

60 

10 

16.7 

1899 

869 

100 

11.5 

42 

5 

11.9 

1900 

936 

111 

11.9 

34 

3 

8.8 

1901 

927 

126 

13.6 

43 

6 

14.0 

1902 

1,016 

137 

13.5 

43 

8 

18.6 

1903 

1,062 

132 

12.4 

55 

14 

25.5 

1904 

1,043 

142 

13.6 

47 

3 

6.4 

1905 

1,115 

117 

10.5 

52 

8 

15.4 

1906 

1,120 

141 

12.6 

39 

5 

12.8 

1907 

1,196 

169 

14.1 

36 

5 

13.9 

1908 

1,213 

151 

12.4 

47 

6 

12.8 

1909 

1,189 

148 

12.4 

43 

6 

14.0 

1910 

1,253 

159 

12.7 

41 

2 

4.9 

1911 

1,277 

158 

12.4 

41 

4 

9.8 

1912 

1,263 

163 

12.9 

47 

7 

14.9 

1913 

1,302 

168 

12.9 
11.8 

34 
495 

5 

72 

14.7 

1893-1903 

9,563 

1,131 

14.6 

1904-1913 

11,971 

1,516 

12.7 

427 

51 

11.9 

Source:     Annual  Reports  of  the  Leipziger  Lebensversicherungs-Gesellschaft,  Leipzig. 


387 


APPENDIX  D 

Table  85 

Mortality  Experience  of  the  Leipzig  Life  Insurance  Company,  Germany 

Mortality  from  Cancer,  according  to  Age,  Males 

1893-1912 


Ages 
15-30. 
31-40. 
41-50. 
51-60. 
61-70. 
71-85. 


1893-1902 

1903-1912 

Deaths 

Deaths 

Deaths 

Deaths 

from  All 

from 

Cancer 

from  All 

from 

Cancer 

Causes 

Cancer 

Per  Cent. 

Causes 

Cancer 

Per  Cent 

174 

7 

4.0 

272 

6 

2.2 

817 

42 

5.1 

986 

66 

6.7 

1,766 

180 

10.2 

2,152 

223 

10.4 

2,458 

352 

14.3 

3,110 

486 

15.6 

2,018 

288 

14.3 

2,958 

473 

16.0 

1,268 

130 

10.3 

2,253 

226 

10.0 

Total 8,501  999  11.8  11,731         1,480  12.6 

Source:     Annual  Reports  of  the  Leipziger  Lebensversicherungs-Gesellschaft,  Leipzig. 


Table  86 
Mortality  Experience  of  the  Magde- 
burg Life  Insurance  Company 
Germany 
Mortality  from  Cancer 
1901-1913 


Year 

Deaths 
from  All 
Causes 

Deaths 

from 

Cancer 

Cancer 
Per  Cent 

1901 

736 

57 

7.7 

1902 

740 

64 

8.6 

1903 

807 

78 

9.7 

1904 

699 

59 

8.4 

1905 

750 

76 

10.1 

1906 

703 

82 

11.7 

1907 

762 

91 

11.9 

1908 

803 

69 

8.6 

1909 

742 

72 

9.7 

1910 

815 

92 

11.3 

1911 

890 

93 

10.4 

1912 

885 

94 

10.6 

1913 

883 

112 

12.7 

1901-1913. 


10,215         1,039 


10.2 


Source :  Annual  Reports  of  the  Magde- 
burger  Lebensversicherungs-Gesellschaft, 
Magdeburg. 


Table  87 
Mortality  Experience  of  the  Magde- 
burg Life  Insurance  Company 

Germany 

Mortality  from  Cancer,  by  Age 

1901-1913 


Deaths 

from  All 

Ages  Causes 

Under  30 247 

30-39 1,199 

40-49 2,010 

50-59 2,241 

60-69 2,117 

70  and  over...  2,401 

Total 10,215 


Deaths 
from 
Cancer 


160 


323 
211 


1,039 


Cancer 
Per  Cent. 

0.4 

4.3 

8.0 

13.0 

15.3 


10.2 


Source:  Annual  Reports  of  the  Magde- 
Ijurger  Lebensversicherungs-Gesellschaft, 
Magdeburg. 


APPEXDIX  D 

Table  88 

Mortality  Experience  of  the  Saxon  Military  Life  Insurance  Society 

Dresden,  Germany 

Mortality  from  Cancer,  by  Organs  and  Parts,  according  to  Sex 

1903-1906 


MALES 


Organ  or  Part 

Tongue 

Larynx 

(Esophagus 

Stomach 

Liver 

Intestines 

Kidney  and  bladder. 

Lungs 

Breast 

Uterus  and  ovary. . . 
Other  organs 


Deaths 

from 
Cancer 

4 

2 

8 

64 

13 

16 

5 


Per 

Cent. 

3.2 

1.6 

6.3 

50.8 

10.3 

12.7 

4.0 

4.0 


7.1 


All  organs 126 


100.0 


FEMALES 

Deaths 
from 
Cancer 

Per 
Cent. 

2 

1.9 

47 

45.2 

7 

6.7 

0 

4.8 

i 

1.6 

4 

3.8 

28 

26.9 

10 

9.7 

104 


100.0 


Males.  .  . 
Females . 


MORTALITY  FROM  CANCER,  BY  SEX,  1903-1906 

Deaths  from  All  Causes    Deaths  from  Cancer  Cancer  Per  Cent. 

1,545  126  8.2 

874  104  11.9 


Source: 


Total... 2,419  230  9.5 

Annual  Reports  of  Sachsischer  Militar  Lebensversichenmgs-Verein,  Dresden. 


Table  89 

Table  90 

Mortality  Experience  of   the 

Stutt- 

Mortality  Experience 

of  the 

"Teu- 

gart  Life  Insurance  Comp 

any 

tonia"  Life  Insurance  Company 

Germany 

Germany 

Mortality  from  Cancer,  by  Age 

Mortality  from  Cancer,  by  Age 

1901-1906 

)eaths 

1905-191 

2 

Deaths 

Deaths          r 

Deaths 

from  All 

rom 

Cancer 

from  AU 

from 

Cancer 

Ages 

Causes          Cancer 

Per  Cent. 

Ages                       Causes 

Cancer 

Per  Cent. 

Under  30 . 

215 

4 

1.9 

20-30 165 

1 

0.6 

30-34 

259 

11 

4.2 

31-40 681 

39 

5.7 

35-39 

432 

28 

6.5 

41-50 1,234 

126 

10.2 

40-44 

560 

43 

7.7 

51-60 1,760 

245 

13.9 

45-49 

715 

90 

12.6 

61-70 2,602 

428 

16.4 

50-54  

833 

99 

11.9 

71-80 2,503 

298 

11.9 

55—59 .... 

890 

143 

16.1 

81  and  over...         835 

29 

3.5 

60-64 

879 

141 

16.0 

65-69 

742 

105 

14.2 

Total 9.780 

1,166 

11.9 

70-74.... 

675 

96 

14.2 

75-79 

426 

32 

7.5 

Source:    Annual  Report 

s  of  the  Teutonia 

80-89 

327 

25 
817 

7.6 
11.8 

Versicherungs-Actien-Gesellschaft, 

Leipzig. 

Total  .  . 

. .  .     6,953 

Source: 

Annual  Report 

s  of  the  Stutt- 

garter  Lebensversicherungsbank,  Stuttgart. 

389 


APPENDIX  D 

Table  91 

Mortality  Experience  of  the  "Victoria"  Life  Insurance  Company,  Berlin 

Mortality  from  Cancer,  1903-1913 

Deaths 

from  All 

Year  Causes 

1903 861 

1904 1,014 

1905 1,103 

1906 1,218 

1907 1,247 

1908 1,434 

1909 1,522 

1910 1,515 

1911 1,783 

1912 1,890 

1913 2,146 


Deaths 
from 
Cancer 

Cancer 
Per  Cent. 

73 

8.5 

87 

8.6 

91 

8.3 

104 

8.5 

101 

8.1 

121 

8.4 

127 

8.3 

142 

9.4 

153 

8.6 

180 

9.5 

206 

9.6 

1903-1913...    15,733         1,385  8.8 

Source:     Annual  Reports  of  the  "Vic- 
toria zu  Berlin,"  Berlin. 


Table  92 

Mortality  Experience  of  Austrian  Life  Insurance  Companies 

Mortality  from  Cancer,  1899-1912 

Deaths 

Number  of  from  All 

Year  Companies  Causes 

1899 2  1,495 

1900 , 4  3,048 

1901 6  4,499 

1902 6  4,401 

1903 5  3,755 

1904 7  4,553 

1905 8  5,481 

1906 9  5,467 

1907 12  7,820 

1908 12  8,362 

1909 13  9,371 

1910 13  9,294 

1911 13  9,795 

1912 13  9,979 

1899-1912 87,320  8,234  9.4 

Source:     Annual  Reports  of  the  several  companies. 


Deaths 

from 

Cancer 

Cancer 

Per  Cent, 

129 

8.6 

316 

10.4 

398 

'       8.8 

396 

9.0 

413 

11.0 

455 

10.0 

479 

8.7 

550 

10.1 

736 

9.4 

767 

9.2 

827 

8.8 

871 

9.4 

920 

9.4 

977 

9,8 

390 


APPENDIX  D 

Table  93 

Mortality  Experience  of  Austrian  Life  Insurance  Companies 

Mortality  from  Cancer,  by  Age 

1899-1912 


Deaths  Deaths 

from  All  from  Cancer 

•   Ages  Causes  Cancer        Per  Cent. 

Under  31 4,498  67  1.5 

31-35 4,802  156  3.2 

36-40 6,933  348  5.0 

41-45 8,703  582  6.7 

46-50 9,875  1,015  10.3 

51-55 ! .  .  10,107  1,233  12.2 

56-60 10,218  1,387  13.6 

61-65 9,352  1,326  14.2 

66-70 7,988  1,041  13.0 

71-75 6,478  640  9.9 

76-80 4,840  328  6.8 

81-85 2,759  98  3.6 

86  and  over...  767  13  1.7 

Total 87,320        8,234  9.4 

Source:     Annual  Reports  of  the  several 
companies. 

Table  94 

Mortality  Experience  of  Austrian  Life  Insurance  Companies 

Mortality  from  Cancer,  according  to  Age 

1876-1890  Compared  with  1891-1900 


1876-1890 

1891-1900 

Deaths 

Deaths 

Deaths 

Deaths 

from  Ail 

from 

Cancer 

from  All 

from 

Cancer 

Ages 

Causes 

Cancer 

Per  Cent. 

Causes 

Cancer 

Per  Cent. 

17-29 

473 

2 

0.4 

580 

8 

1.4 

30-34 

1,103 

27 

2.4 

1,299 

38 

2.9 

35-39 

1,802 

89 

4.9 

2,244 

94 

4.2 

40-44 

2,481 

146 

5.9 

3,094 

193 

6.2 

45-49 

2,907 

247 

8.5 

3,722 

365 

9.8 

50-54 

3,235 

274 

8.5 

3,852 

456 

11.8 

55-59 

3,536 

365 

10.3 

3,883 

482 

12.4 

60-64 

3,410 

316 

9.3 

3,255 

417 

12.8 

65-69 

3,009 

258 

8.6 

3,132 

395 

12.6 

70-74 

1,669 

164 

9.8 

2,006 

215 

10.7 

75-79 

1,070 

45 

4.2 

1,684 

112 

6.7 

80-84 

425 

6 

1.4 

789 

33 

4.2 

85-98 

75 

2 

2.7 
7.7 

150 

2 

1.3 

Total 

25,195 

1,941 

29,690 

2,810 

9.5 

Source:  Versichenmgswissenschaftliche  Mitteilungen,  IX.  Band,  l.Heft.  Vienna,  1914. 


391 


APPENDIX  D 

Table  95 
Mortality  Experience  of  Austrian  Life  Insurance  Companies,  1876-1900 
Probability  of  Death  from  Cancer  Multiplied  by  100,000 


Ages  1876-1880 

17-29 

30-34 20.37 

35-39 56.28 

40-44 78.70 

45-49 152.27 

50-54 243.81 

55-59 298.82 

60-64 346.91 

65-69 553.88 

70-74 999.48 

75-79 64.02 

80-84 

85-98 


1881-1885 

1886-1890 

1891-1895 

1896-1900 

5.33 

12.18 

2.04 

24.15 

14.36 

19.92 

11.39 

50.09 

38.56 

39.84 

21.25 

95.47 

55.95 

69.86 

50.03 

166.03 

126.86 

160.97 

107.22 

171.47 

206.42 

262.79 

189.57 

334.19 

362.41 

368.29 

327.43 

395.76 

455.04 

519.90 

446.88 

503.06 

576.39 

804.91 

668.88 

940.54 

824.59 

818.44 

886.88 

654.35 

623.06 

608.54 

934.40 

511.04 

169.96 

807.13 

694.01 

1284.16* 

435.96 

Source:  YersicherungswissenschaftlicheMitteilungen,  IX.  Band,  1.  Heft.  Vienna,  1914. 

*Based  on  only  two  deaths. 


Table  96 

Mortality  Experience  of  "Der 

Anker"  Life  Insurance  Company 

Vienna,  Austria 

Mortality  from  Cancer,  by  Age 

1901-1913 


Ages 

Deaths 
from  All 
Causes 

Deaths 

from 
Cancer 

Cancer 
Per  Cent 

30  and  under . 

1,034 

22 

2.1 

31-35 

415 

13 

3.1 

36-40 

581 

17 

2.9 

41-45 

782 

40 

5.1 

46-50 

871 

65 

7.5 

51-55 

914 

89 

9.7 

56-60 

775 

80 

10.3 

61-65 

690 

78 

11.3 

66-70 

603 

70 

11.6 

71-75 

612 

24 

3.9 

76-80 

428 

12 

2.8 

81-85 

302 

4 

1.3 

86  and  over. . . 

151 

514 

Total 

8,158 

6.3 

Source:    Annual  Reports  of  the  Life  In- 
surance Company  "Der  Aaker,"  Vienna. 
Note:     1903  is  missing. 


Table  97 

Mortality  Experience  of  the"  Assicur- 

azioni  Generali,"  Trieste,  Austria 

Mortality  from  Cancer 

1899-1912 


Deaths 

from  All 

Year  Causes 

1899 943 

1900 895 

1901 947 

1902 1,035 

1903 1,063 

1904 1,016 

1905 1,145 

1906 1,075 

1907 1,192 

1908 1,209 

1909 1,292 

1910 1,238 

1911 1,295 

1912 1,277 

Total 15,622 


Deaths 

from 
Cancer 

Cancer 
Per  Cent 

77 

8.2 

90 

10.1 

92 

9.7 

97 

9.4 

93 

8.7 

94 

9.3 

107 

9.3 

101 

9.4 

137 

11.5 

120 

9.9 

114 

8.8 

123 

9.9 

102 

7.9 

114 

8.9 

1,461 


9.4 


Source :  Annual  Reports  of  the  " Assicura- 
zioni  Generali,"  Trieste. 


392 


APPENDIX  D 


Table  98 

Table  99 

Mortality  Experience  of  the 

"Assi- 

Mortality  Experience 

of  th 

e  Life 

curazioni  Generali," 

Trieste, 

Austria 

Insurance 

Company 

"Donau," 

Mortality 

from  Cancer,  by  Age 

Vienna,  Austria 

1899-1912 

Mortality  from  Cancer,  by  Age 

1908-1912 

Deaths 
from  All 

Deaths 
from 

Cancer 

Dfeaths          Deaths 

Ages 

Causes 

Cancer 

Per  Cent. 

from  All 

rom 

Cancer 

30  and  under . 

579 

13 

2.2 

Ages 

Causes          Cancer 

Per  Cent. 

31-35 

836 

36 

4.3 

30  and  under . 

72 

1 

1.4 

36-40 

1,270 

63 

5.0 

31-35 

117 

6 

5.1 

41-45 

1,660 

115 

6.9 

36-40 

156 

7 

4.5 

46-50 

1,850 

194 

10.5 

41-45 

175 

10 

5.7 

51-55 

1,782 

213 

12.0 

46-50 

250 

22 

8.8 

56-60 

1,672 

233 

13.9 

51-55 

248 

34 

13.7 

61-65 

1,408 

192 

13.6 

56-60 

272 

40 

14.7 

66-70 

1,337 

159 

11.9 

61-65 

261 

45 

17.2 

71-75 

1,303 

121 

9.3 

66-70 

214 

27 

12.6 

76-80 

1,150 

86 

7.5 

71-75 

172 

25 

14.5 

81-85 

692 

32 

4.6 

76-80 

136 

10 

7.4 

86  and  over. . . 

83 

4 

4.8 
9.4 

81  and  over.. . 
Total 

91 

227 

Total 

15,622 

1,461 

2,164 

10.5 

Source:  Annual  Reports  of  the  " 

Assicura- 

Source:    Annual  Reports 

>  of  the  Life  In- 

zioni  Generali, 

'  Trieste. 

surance  Company  "Donau, 

'  Vienna. 

Table  100 

Table  101 

Mortality  Experience  of  the  First 

Mortality  Experience  of  the 

General  Association  of 

Mutual  Life  Insurance  Company 

Austro-Hungarian  Ofificials 

"Janus 

,"  Vienna, 

Austria 

Vienna,  Austria 

Mortality  from  Cancer,  by  Age 

Mortality  from  Cancer,  by  Age 

1907-1912 

1900-191^ 

Deaths 

Deaths 

from  AU 

from 

Cancer 

from  All 

from 

Cancer 

Ages 

Causes 

^ancer 

Per  Cent. 

Age3 

Causes 

Cancer 

Per  Cent. 

30  and  under . 

125 

4 

3.2 

30  and  under . 

279 

3 

1.1 

31-35 

216 

9 

4.2 

31-35 

581 

12 

2.1 

36-40 

255 

17 

6.7 

36-40 

939 

37 

3.9 

41-45 

331 

30 

9.1 

41-45 

1,283 

86 

6.7 

46-50 

364 

46 

12.6 

46-50 

1,649 

182 

11.0 

51-55 

387 

51 

14.7 

51-55 

2,104 

267 

12.7 

56-60 

388 

59 

15.2 

56-60 

2,559 

380 

14.8 

61-65 

346 

44 

12.7 

61-65 

2,569 

391 

15.2 

66-70 

350 

45 

12.9 

66-70 

2,259 

328 

14.5 

71-75 

330 

25 

7.6 

71-75 

1,668 

203 

12.2 

76-80 

284 

22 

7.7 

76-80 

1,085 

85 

7.8 

81-85 

162 

8 

4.9 

81-85 

86  and  over. . . 

532 

26 

4.9 

86  and  over. . . 

140 

4 

2.9 

Total 

3,678 

370 

10.1 

Total 

17,507 

2,000 

11.4 

Soiu-ce:    Annual  ReDorts  of  the  Mutual 

Source :    Annual  Reports  of  Erster  Allge- 

Life  Insurance 

Company  ".Janus." 

Vienna. 

meiner  Beamten-Verein 

der  Osterreichisch- 

Ungarischen  Monarchic 

Wien. 

393 


APPENDIX  D 


Table  102 

Mortality  Experience  of  the  Life 

Insurance  Company  of  the  "Mar- 

graviate   Moravia,"    Briinn,  Austria 

Mortality  from  Cancer,  by  Age 

1906-1912 


Deaths 

Deaths 

from  All 

from 

Cancer 

Ages 

Causes 

Cancer 

Per  Cent. 

30  and  under . 

195 

2 

1.0 

31-35 

183 

2 

1.1 

36-40 

269 

12 

4.5 

41-45 

238 

19 

8.0 

46-50 

228 

20 

8.8 

51-55 

159 

25 

15.7 

56-60 

117 

12 

10.3 

61-65 

54 

8 

14.8 

66-70 

21 

4 

19.0 

71  and  over.. . 

2 

104 

Total 

1,466 

7.1 

Source:  Annual  Reports  of  the  Landes- 
Lebensversicherung.s-Anstalt  der  Mark- 
grafschaft  Mahren,  Briinn. 


Table  103 

Mortality  Experience  of  the 

Mutual  Life  Insurance  Company 

of  Krakau,  Austria 

Mortality  from  Cancer,  by  Age 

1905-1912 


Deaths  Deaths 

from  All  from  Cancer 

Ages                Causes  Cancer  Per  Cent. 

30  and  under.          82  3  3.7 

31-35 197  6  3.0 

36-40 420  20  4.8 

41-45 570  40  7.0 

46-50 597  46  7.7 

51-55 604  52  8.6 

56-60 524  68  13.0 

61-65 507  76  15.0 

66-70 324  40  12.4 

71-75 184  26  14.1 

76-80 118  8  6.8 

81  and  over.. .  47 

Total 4,174  385  9.2 

Source:    Annual  Reports  of  the  Krakau 

Mutual  Life  Insurance  Company,  Krakau. 


Table  104 

Mortality  Experience  of  the 

'Phoenix"  Life  insurance  Company 

Vienna,  Austria 

Mortality  from  Cancer 

1901-1913 


Deaths  Deaths 

from  All  from  Cancer 

Year                           Causes  Cancer        Per  Cent. 

1901 729  38  5.2 

1902 785  5Q  7.1 

1903 774  87  11.2 

1904 790  73  9.2 

1905 915  73  8.0 

1906 873  85  9.7 

1907 929  100  10.8 

1908 963  110  11.4 

1909 1,016  102  10.0 

1910 1,001  84  8.4 

1911 954  93  9.7 

1912 895  107  12.0 

1913 847  80  9.4 

Total 11,471  1,088  9.5 

Source:    Annual  Reports  of  the  Oster- 
reichischer  Phoenix,  Vienna. 


394 


APPENDIX  D 


Table  105 

Mortality  Experience  of  the  "Phoenix"  Life  Insurance  Company 

Vienna,  Austria 

Mortality  from  Cancer,  by  Age 

1901-1912 


1901-1906 

1907-1912 

Ages 

Deaths 
from  All 
Causes 

Deaths 

from 
Cancer 

Cancer 
Per  Cent. 

Deaths 
from  All 
Causes 

Deaths 

from 

Cancer 

Cancer 
Per  Cent. 

30  and  under 

142 

2 
2 

1.4 

0.8 

160 

262 

2 
9 

1.3 

31-35 

237 

3.4 

36-40 

312 

14 

4.5 

402 

30 

7.5 

41-45 

408 

22 

5.4 

462 

24 

5.2 

46-50 

517 

51 

9.9 

581 

57 

9.8 

51-55 

538 

57 

10.6 

555 

76 

13.7 

56-60 

604 

67 

11.1 

659 

82 

12.4 

61-65 

625 

81 

13.0 

714 

105 

14.7 

66-70 

552 

52 

9.4 

718 

111 

15.5 

71-75 

428 

45 

10.5 

570 

65 

11.4 

76-80 

312 

16 

5.1 

382 

26 

6.8 

81-85 

141 

3 

2.1 

217 

8 

3.7 

86  and  over 

50 

412 

8.5 

76 

1 
596 

1.3 

Total 

4,866 

5,758 

10.4 

Source:    Annual  Reports  of  the  Osterreichischer  Phoenix,  Vienna. 


Table  106 

Mortality  Experience  of  the  "Praha" 

Mutual  Life  Insurance  Company 

Prague,  Austria 

Mortality  from  Cancer,  by  Age 

1900-1907 


Deaths  Deaths 

from  All  from  Cancer 

Ages                Causes  Cancer  Per  Cent. 

30  and  under.           97  1  1.0 

31-35 123  5  4.1 

36-40 140  7  5.0 

41-45 170  9  5.3 

46-50 185  26  14.1 

51-55 156  26  16.7 

56-60 145  20  13.8 

61-65 157  21  13.4 

66-70 135  16  11.9 

71-75 79  3  3.8 

76-80 30  4  13.3 

81-85 7 

86  and  over.. . 

Total 1,424  138  9.7 

Source:    Annual  Reports  of  the  Mutual 

Life  Insurance  Company  "Praha,"  Prague, 
Bohemia. 


Table  107 

Mortality  Experience  of  the"  Riunione 

Adriatica  Sicurta"  Life  Insurance 

Company,  Trieste,  Austria 

Mortality  from  Cancer,  by  Age 

1899-1912 


Deaths 

Deaths 

from  All 

from 

Cancer 

Ages 

Causes 

Cancer 

Per  Cent 

30  and  under . 

305 

6 

2.0 

31-35 

495 

15 

3.0 

36-40 

721 

42 

5.8 

41-45 

1,040 

73 

7.0 

46-50 

1,142 

120 

10.5 

51-55 

1,165 

123 

10.6 

56-60 

1,113 

130 

11.7 

61-65 

904 

100 

11.1 

66-70 

786 

94 

12.0 

71-75 

694 

59 

8.5 

76-80 

586 

36 

6.1 

81-85 

372 

11 

3.0 

86  and  over.. . 

131 

2 

1.5 

Total 

9,454 

811 

8.6 

Source:  Annual  Reports  of  the  "Riunione 
Adriatica  Sicurta,"  Trieste. 


395 


APPENDIX  D 


Table  108 

Mortality  Experience  of  the 

Industrial  Insurance  Company 

"Universale,"  Vienna,  Austria 

Mortality  from  Cancer,  by  Age 

1907-1912 


Deaths 

from  All 

Ages  Causes 

30 and  under.  1,084 

31-35 680 

36-40 819 

41-45 902 

46-50 949 

51-55 947 

56-60 914 

61-65 820 

66-70 520 

71-75 345 

76-80 290 

81-85 216 

86  and  over...  108 

Total 8,594 


Deaths 

from 

Cancer 

6 

23 

45 

60 

102 

140 

146 

134 

73 

37 

16 

6 

2 

790 


Cancer 
Per  Cent, 

0.6 

3.4 

5.5 

6.7 

10.7 

14.8 

16.0 

16.3 

14.0 

10.7 

5.5 

2.8 

1.9 

9.2 


Source:  Annual  Reports  of  the  Indus- 
trial Life  Insurance  Company  "Univer- 
sale," Vienna. 


Table  109 

Mortality  Experience  of  the 

"Fonciere"  Life  Insurance  Company 

Budapest,  Hungary 

Mortality  from  Cancer,  by  Age 

1900-1912 


Deaths 

from  All 

Ages  Causes 

30  and  under .  134 

31-35 159 

36-40 311 

41-45 397 

46-50 476 

51-55 419 

56-60 420 

61-65 303 

66-70 246 

71-75 147 

76-80 69 

81-85 30 

86  and  over...  6 

Total 3,117 


Deaths 

from 

Cancer 

2 
7 
12 
32 
34 
46 
48 
42 
17 
10 


253 


Cancer 
Per  Cent. 

1.5 

4.4 

3.9 

8.1 

7.1 

11.0 

11.4 

13.9 

6.9 

6.8 

4.3 


8.1 


Source:  Annual  Reports  of  the  "Fon- 
ciere," Pester  Versicherungs-Anstalt,  Buda- 
pest, Hungary. 


Table  110 

Mortality  Experience  of  the 

'Basle"  Life  Insurance  Company 

Switzerland,  1865-1897 


MORTALITY  FROM  CANCER 


Years 
1865-1877. 
1878-1887. 
1888-1897. 


Deaths 
from  All 
Causes 

1,482 
2,332 
3,252 


Deaths 

from 

Cancer 

103 
190 
347 


Cancer 
Per  Cent. 

6.95 

8.15 

10.67 


1865-1897...     7,066  640  9.06 

MORTALITY  FROM  CANCER,  BY  SEX 
Males 5,755  500  8.69 


Females . 


927 


140 


15.10 


Source:  7066  Todesfalle  der  Easier 
Lebensversicherungs-Gesellschaft  medi- 
zinish  und  statistisch  bearbeitet  von  Dr. 
Arthur  Hesse.     Leipzig,  1899. 


Table  111 

Mortality  Experience  of 

'La  Suisse"  Life  Insurance  Company 

Lausanne,  Switzerland 

Mortality  from  Cancer,  by  Age 

1901-1913 


Deaths 

from  All 

Ages  Causes 

21-30 41 

31-40 162 

41-50 225 

51-60 269 

61-70 274 

71-80 225 

81-90 57 

Total 1,253 


Deaths 

from 

Cancer 

2 
7 
20 
30 
36 
22 
3 

129 


Cancer 
Per  Cent. 

4.9 
4.3 
8.9 
14.5 
13.1 
9.8 
5.3 

10.3 


Source:  Annual  Reports  of  "La  Suisse" 
Societe  d'Assurances  sur  la  vie  et  contre 
les  accidents,  Lausanne. 


396 


APPENDIX  D 

Table  112 

Mortality  Experience  of  the  Life  Insurance  Company  "Thule" 

Stockholm,  Sweden 

Mortality  from  Cancer  and  Other  Tumors 

1873-1902 


Deaths 

Deaths 

from  All 

from 

Cancer 

Year 

Causes 

Cancer 

Per  Cent. 

1873 

1 

1874 

4 

i 

25.0 

1875 

12 

1876 

6 

1877 

12 

1878 

14 

1879 

11 

3 

27.3 

1880 

10 

1881 

18 

i 

5.6 

1882 

21 

1 

4.8 

1873-1882  

109 

6 

5.5 

1883 

24 

2 

8.3 

1884 

23 

3 

13.0 

1885 

42 

3 

7.1 

1886 

32 

2 

6.3 

1887 

33 

1 

3.0 

1888 

35 

4 

11.4 

1889 

40 

4 

10.0 

1890 

58 

4 

6.9 

1891 

70 

3 

4.3 

1892 

86 

3 

3.5 

1883-1892  

443 

29 

6.5 

1893 

103 

9 

8.7 

1894 

97 

9 

9.3 

1895 

92 

10 

10.9 

1896 

123 

15 

12.2 

1897 

152 

17 

11.2 

1898 

133 

11 

8.3 

1899 

151 

15 

9.9 

1900 . 

181 

19 

10.5 

1901 

236 

25 

10.6 

1902 

201 

21 
151 

10.4 

1893-1902  

1,469 

10.3 

Source:      Lifsforsakringsaktiebolaget     Thule, 
Trettio  Ars  Verksamhet,  1873-1902. 


Stockholm, 


397 


APPENDIX  D 

Table  113 

Mortality  Experience  of  The  Australian  Mutual  Provident  Society 

Mortality  from  Cancer,  by  Age  and  Sex 

1849-1888 


MALES 

FEMALES 

Ages 

Deaths 
from  All 
Causes 

Deaths 
from 
Cancer 

Cancer 
Per  Cent. 

Deaths 
from  AU 
Causes 

Deaths 

from 
Cancer 

Cancer 
Per  Cent. 

19-24 

204 

2 

1.0 

7 

25-29 

358 

2 

0.6 

10 

80-34 

493 

7 

1.4 

23 

35-39 

628 

13 

2.1 

40 

40-44 

776 

27 

3.5 

25 

4 

16.6 

45-49 

804 

42 

5.2 

20 

3 

15.0 

50-54 

705 

49 

7.0 

28 

7 

25.0 

55-59 

543 

33 

6.1 

22 

5 

22.7 

60-64 

379 

30 

7.9 

17 

4 

23.5 

65-69 

269 

14 
10 

5.2 
9.5 

12 
9 

2 

70-74 

105 

22.2 

75-79 

45 

3 

6.7 

6 

80  and  over 

16 

2 

Total 

5,325 

232 

4.4 

221 

25 

11.3 

Source:     Report  on  the  Mortality  Experience  of  The  Australian  Mutual  Pro\adent 
Society  for  the  forty  years  1849  to  1888. 

Table  114 

Mortality  Experience  of  The  Australian  Mutual  Provident  Society 

Mortality  from  Tumor,  by  Age  and  Sex 

1849-1888 


MALES 

FEMALES 

Deaths 

Deaths 

Deaths 

Deaths 

from  AU 

from 

Tumor 

from  All 

from 

Tumor 

Ages 

Causes 

Tumor 

Per  Cent. 

Causes 

Tumor 

Per  Cent. 

19-24 

204 

7 

25-29 

358 

10 

30-34 

493 

1 

0.2 

23 

35-39 

628 

1 

0.2 

40 

40-44 

776 

2 

0.3 

25 

45-49 

804 

2 

0.2 

20 

1 

5.0 

50-54 

705 

1 

0.1 

28 

55-59 

543 

1 

0.2 

22 

60-64 

379 

1- 

0.3 

17 

65-69 

269 

12 

70-74 

105 

1 

1.0 

9 

75-79 

45 

6 

80  and  over 

16 

2 

Total 

5,325 

10 

0.2 

221 

1 

0.5 

Source:     Report  on  the  Mortality  Experience  of  The  Australian  Mutual  Provident 
Society  for  the  forty  years  1849  to  1888. 


398 


APPENDIX  D 


Table  115 

Mortality  Experience  of 

The  Oriental  Government  Security 

Life  Assurance  Company 

Bombay,  British  India 

Mortality  from  Cancer,  by  Race 

1897-1913 


Deaths 

Deaths 

Deaths 

Deaths 

from  AU 

from 

Cancer 

from  All 

from 

Cancer 

Causes 

Cancer 

Per  Cent. 

Ages 

Causes 

Cancer 

Per  Cent 

Hindoos 

7,281 

70 

0.96 

Under  40.  .  . 

43 

1 

2.3 

Europeans.  .  . 

840 

33 

3.93 

40-49 

43 

2 

4.7 

Parsees 

637 

12 

1.88 

50-64 

51 

11 

21.6 

Mahomedans 

259 

1 
116 

0.39 
1.29 

65  and  over. . 
Total  .... 

24 
161 

1 
15 

4.2 

Total 

9,017 

9.3 

Source:  Annual  Reports  of  The  Oriental 
Government  Security  Life  Assurance  Com- 
pany, Limited. 


Table  116 

Mortality  Experience  of 

The  Dutch  East  Indian  Life 

Insurance  Company 

Batavia,  Dutch  East  Indies 

Mortality  from  Cancer,  by  Age 

1911-1913 


Source:  Annual  Reports  of  the  Neder- 
landsch-Indische  LelDensverzekeringen 
Li jf rente  Maatschappij,  Batavia,  Dutch 
East  Indies. 


Table  117 

Mortality  Experience  of  the  Meiji  Life  Assurance  Company,  Japan 

Mortality  from  Cancer,  by  Sex 

1899-1907 


.    Year 

1899 

1900 

1901 

1902 

1903 

1904 

1905 

1906 

1907 

1899-1907. 


1899-1907. 


5,919 


IMALES 


529 
TOTAL 


8.9 


FEiLALES 


Deaths 
from  All 
Causes 

Deaths 

from 
Cancer 

Cancer 
Per  Cent. 

Deaths 
from  All 
Causes 

Deaths 

from 

Cancer 

Cancer 
Per  Cent 

417 

33 

7.9 

91 

9 

9.9 

443 

32 

7.2 

95 

11 

11.6 

505 

39 

7.7 

104 

13 

12.5 

618 

62 

10.0 

180 

18 

10.0 

615 

64 

10.4 

160 

24 

15.0 

787 

56 

7.1 

180 

31 

17.2 

851 

90 

10.6 

210 

20 

9.5 

743 

70 

9.4 

238 

27 

11.3 

940 

83 

8.8 

296 

27 

9.1 

1,554 


180 


Deaths 

Deaths 

from  All 

from 

Cancer 

Causes 

Cancer 

Per  Cent 

7,473 


709 


9.5 


11.6 


Source:     Mortality  Experience  in  the  Meiji  Life  Assurance  Company,  1899  to  1907. 


399 


APPENDIX  D 

Table  118 

Mortality  Experience  of  the  Meiji  Life  Assurance  Company,  Japan 

Mortality  from  Carcinoma,  by  Age  and  Sex 

1899-1907 


Total 

Males 

Females 

Number  of 

Number  of 

Number  of 

Ages 

Deaths 

Per  Cent. 

Deaths 

Per  Cent. 

Deaths 

Per  Cent, 

25-29 

3 

0.4 

2 

0.4 

1 

0.6 

30-34 

11 

1.6 

4 

0.8 

7 

4.0 

35-39 

36 

5.2 

18 

3.5 

18 

10.2 

40-44 

72 

10.4 

49 

9.5 

23 

13.0 

45-49 

114 

16.4 

85 

16.4 

29 

16.4 

50-54 

153 

22.0 

125 

24.1 

28 

15.8 

55—59 

149 

21.4 

115 

22.2 

34 

19.2 

60-64 

106 

15.3 

83 

16.0 

23 

13.0 

65-69 

36 

5.2 

28 

5.4 

8 

4.5 

70-74 

15 

2.2 

9 

1.7 

6 

3.4 

Total 

695 

100.0 

518 

100.0 

177 

100.0 

Source:     Mortality  Experience  in  the  Meiji  Life  Assurance  Company,  1899  to  1907. 

Table  119 

Mortality  Experience  of  the  Meiji  Life  Assurance  Company,  Japan 

Mortality  from  Cancer,  by  Organs  and  Parts,  according  to  Sex 

1899-1907 


Total 

Number  of 

Carcinoma  of  Deaths  Per  Cent. 

Buccal  ca\nty 16  2.3 

Larj'nx 16  2.3 

(Esophagus 88  12.4 

Stomach 371  52.3 

Liver 52  7.3 

Intestines  and  peritoneum ..  .  44  6.2 

Kidneys  and  urethra 7  1.0 

Lungs  and  pleura 5  0.7 

Uterus 79  11.1 

Breast 4  0.6 

Neck 6  0.8 

Other  organs 7  1.0 

Sarcoma 14  2.0 

Allorgans 709  100.0 


Males 


Number  of 

Deaths      Per  Cent. 


16 
14 

85 

306 

42 

33 

6 

4 


6 

6 

11 

529 


3.0 
2.6 
16.1 
57.8 
7.9 
6.2 
1.1 
0.8 


1.1 
1.1 
2.1 

100.0 


Females 


Number  of 
Deaths 


3 
65 
10 
11 

1 

1 
79 

4 


180 


Per  Cent. 

i.i 

1.7 

36.1 
5.6 
6.1 
0.6 
0.6 

43.9 


0.6 
1.7 


100.0 


Source:     Mortality  Experience  in  the  Meiji  Life  Assurance  Company,  1899  to  1907. 


400 


APPENDIX  D 

Table  120 

Mortality  Experience  of  Domestic  Life  Insurance  Companies  of  Japan 

Mortality  from  Cancer,  by  Organs  and  Parts 

according  to  Age  and  Sex,  1910-1912 


Ages 


Deaths 
from  All 
Causes 


20  and  under 799 

21-30 3,600 

31-40 5,863 

41-50 7,407 

51-60 7,381 

61-70 4,543 

71-80 800 

81-90 9 


Total 30,402 


MALES 

Cancer  of  Stomach 

Per  Cent, 
of  All 

Causes 


Deaths 


105 
376 
688 
411 
49 
1 

1,638 


0.0 
0.2 
1.8 
5.1 
9.3 
9.0 
6.1 
11.1 

5.4 


Cancer  of  Other  Organs 

Per  Cent, 
of  All 
Causes 


Deaths 


6 

40 
205 
372 
217 


868 


0.0 
0.2 
0.7 
2.8 
5.0 
4.8 
3.5 
0.0 


Deaths 


Cancer  of  All  Organs 

Per  Cent, 
of  All 
Causes 

0.0 

0.4 

2.5 

7.9 

14.3 

13.8 

9.6 

11.1 


14 

145 

581 

1,060 

628 

77 

1 

2,506 


8.2 


20  and  under 400 

21-30 1,788 

31-40 2,605 

41-50 2,155 

51-60 2,250 

61-70 1,800 

71-80 477 

81-90 7 


Total 11,482 


5 

27 

75 

160 

122 

21 


FEMALES 
0.0 
0.3 
1.0 
3.5 
7.1 
6.8 
4.4 


410 


3.6 


7 

61 

113 

121 

84 

18 


404 


0.0 

0.4 
2.3 
5.2 

5.4 

4.7 
3.8 


3.5 


12 

88 

188 


206 
39 


814 


0.0 

0.7 
3.3 
8.7 
12.5 
11.5 
8.2 
0.0 

7.1 


Source:    The  Insurance  Year  Book,  1910-1912,  Department  of  Agriculture  and  Com- 
merce, Japan. 

Table  121 

Mortality  Experience  of  Foreign  Life  Insurance  Companies  of  Japan 

Mortality  from  Cancer  by  Organs  and  Parts 

according  to  Age,  Males,  1912 


Ages 

20  and  under . 

21-30 

31-40... 

41-50 

51-60 

61-70 


Total . 


Deaths 
from  All 
Causes 

5 

13 

62 

103 

79 

28 

290 


MALES 

Cancer  of  Stomach 

Per  Cent. 
Deaths       of  All 
Causes 


1.9 
10.1 
10.7 

4.5 


13 


Cancer  of  Other  Organs 

Per  Cent. 
Deaths  of  All 

Causes 


4 

11 

5 

20 


3.9 
13.9 
17.9 

6.9 


Cancer  of  All  Organs 

Per  Cent, 
of  All 
Causes 


Deaths 


6 
19 


33 


5.8 
24.0 
28.6 

11.4 


Source:    The  Insurance  Year  Book,  1912,  Department  of  Agriculture  and  Commerce, 
Japan. 

Note :    There  were  no  cases  of  cancer  in  the  female  experience. 


401 


APPENDIX 

E 

Cancer  Mortality  According  to  Latitude, 

Size  or  Cities,  and  Specified  Organs  and  Parts 

Throughout  the  World 


Table  Page 

1  Mortality  from  Cancer  in  Large  Cities,  according  to  Latitude,  1908-1912 403 

2  Mortality  from   Cancer  in  Large  Cities  of  the  Eastern  and  Western  Hemi- 

spheres, according  to  Latitude,  1908-1912 407 

3  Mortality  from  Cancer  in  Cities,  according  to  Size,  1908-1912 410 

4  Comparative  Mortality  from  Cancer,  by  Organs  and  Parts,  in  Thirteen  Princi- 

pal Countries  of  the  World 413 


402 


APPENDIX  E 

Table  1 

Mortality  from  Cancer  in  Large  Cities,  according  to  Latitude 

1908-1912 


MORE  NORTHERLY  THAN  50°  N.  LATITUDE 


City 

Bergen 

Petrograd 

Kristiania 

Stockholm 

Goteborg 

Aberdeen 

Edinburgh .... 

Glasgow 

Moscow 

Copenhagen. . . 
Kbnigsberg. . . . 

Belfast 

Leeds 

Sheffield 

Hamburg 

Liverpool 

Manchester 

Dublin 

Bremen 

Berlin 

Birmingham. . . 

Amsterdam 

The  Hague. . . . 
Rotterdam .... 

London 

Bristol 

Essen 

Leipzig 

Antwerp 

Dresden 

Cologne 

Brussels 

Liege 

Lille 

Frankfurt  a/M. 

Total 


Deaths 

Rate  per 

Latitude 

Population 

Total 

from 

100,000 

North 

1912 

Population 

Cancer 

Population 

60°24' 

77,404 

383,100 

376 

98.1 

59°57' 

1.990,874 

9,815,760 

8,400 

85.6 

59°55' 

243,967 

1,205,625 

1,229 

101.9 

59°21' 

346,848 

1,712,593 

2,047 

119.5 

57°41' 

172,006 

821,817 

759 

91.2 

57°  8' 

164,932 

814,268 

941 

115.6 

55°57' 

321,119 

1,602,543 

1,918 

119.7 

55°53' 

785,600 

3,918,239 

4,190 

106.9 

55°45' 

1,617,733 

7,050,000 

5,805 

82.3 

55°41' 

570,000 

2,744,628 

4,427 

161.3 

54°43' 

255,684 

1,226,145 

1,487 

121.3 

54°36' 

390,724 

1,915,845 

1,612 

84.1 

53°46' 

447,746 

2,221,718 

2,308 

103.9 

53°37' 

466,408 

2,261,241 

1.894 

83.8 

53°24' 

1,063,201 

5,006,244 

5,276 

105.4 

53°24' 

752,021 

3,716,551 

3,592 

96.6 

53°23' 

724,168 

3,460,469 

3,321 

96.0 

53°23' 

306,218 

1,516,918 

1,701 

112.1 

53°  5' 

316,000 

1,484,152 

1,546 

104.2 

52°30' 

2,100,000 

10,361,160 

13,831 

133.5 

52°30' 

850,947 

2,951,231 

2,592 

87.8 

52°22' 

588,000 

2,874,663 

3,355 

116.7 

52°  4' 

294,540 

1,375,718 

1,490 

108.3 

51°55' 

445,137 

2,137,458 

1,980 

92.6 

51°31' 

4,531,572 

22,671,154 

25,322 

111.7 

51°27' 

359,400 

1,784,270 

1,792 

100.4 

51°27' 

305,024 

1,414,452 

856 

60.5 

51°20' 

605,755 

2,848,078 

2,817 

98.9 

51°13' 

322,275 

1,554,689 

1,376 

88.5 

51°  2' 

557,400 

2,727,750 

3,594 

131.8 

50°52' 

544,329 

2,546,035 

2.404 

94.4 

50°51' 

646,400 

891.295 

939 

105.4 

50°38' 

167,851 

837,517 

878 

104.8 

50°37' 

220,243 

1,076,849 

1,469 

136.4 

50°  6' 

428,500 

1,982,500 

1,850 

93.3 

23,980,086     112,912,675       119,374         105.7 


403 


APPENDIX  E 

Table  1  (continued) 
Mortality  from  Cancer  in  Large  Cities,  according  to  Latitude 

1908-1912 


LATITUDE  50°  N.-40°  N. 

Deaths 

Rate  per 

Latitude 

Population 

Total 

from 

100,000 

City 

North 

1912 

Population 

Cancer 

Population 

49°56' 

49°29' 
49°27' 

159,256 
136,905 
345,416 

715,250 

677,065 

1,649,630 

362 

917 

1,721 

50.6 

Le  Havre 

135.4 

Nuremberg 

104.3 

Paris 

48°50' 

2,872,400 

14,111,481 

15,638 

110.8 

Nancy 

48°40' 

121,688 

591,050 

705 

119.3 

Vienna 

48°14' 

2,077,295 

10,064,070 

12,971 

128.9 

Munich 

48°  9' 

615,000 

2,951,000 

4,936 

•    167.3 

Seattle 

47°36' 

268,500 

1,185,970 

662 

55.8 

Basel 

47°34' 

135,632 

657,827 

752 

114.3 

Budapest 

47°29' 

905,244 

4,337,060 

4,450 

102.6 

Zurich 

47°23' 

199,000 

945,026 

1,053 

111.4 

Beme 

46°57' 

86,900 

417,323 

446 

106.9 

Quebec 

46°48' 

79,300 

379,013 

209 

55.1 

Geneva 

46°12' 

130,000 

621,646 

766 

123.2 

Lyon 

45°42' 

534,132 

2,618,980 

3,908 

149.2 

Montreal. 

45°30' 

484,400 

2,185,680 

1,429 

65.4 

Milan 

45°28' 

609,974 

2,942,130 

3,562 

121.1 

St.  John 

45°14' 

42,691 
436,251 

211,655 

2,089,805 

173 
2,341 

81.7 

Turin 

45°  4' 

112.0 

Minneapolis 

44°58' 

321,146 

1,507,040 

1,052 

69.8 

St.  Paul 

44°52' 

221,832 
263,624 

1,073,718 
1,042,820 

802 
1,184 

74.7 

Bordeaux 

44°50' 

113.5 

44°24' 

275,972 

1,342,350 

1,393 

103.8 

Florence 

43°45' 

235,587 

1,150,665 

1,861 

161.7 

43°43' 

144,682 

710,345 

710 

99.8 

Toronto 

43°40' 

414,000 

1,819,052 

1,313 

72.2 

43°  8' 

232,741 

1,090,742 

996 

91.3 

Milwaukee 

43°  3' 

398,219 

1,869,282 

1,292 

69.1 

Buffalo 

42°53' 

442,567 

2,118,575 

1,879 

88.7 

Boston 

42°22' 

715,711 

3,352,926 

3,545 

105.7 

42°20' 

515,156 

2,328,827 

1,528 

65.6 

Springfield,  Mass 

42°  6' 

94,300 

444,630 

407 

91.5 

41°54' 

550,057 

2,670,945 

2,679 

100.3 

Chicago 

41°53' 

2,282,623 

10,926,412 

8,618 

78.9 

Providence 

41°50' 

234,602 

1,121,628 

1,098 

97.9 

Hartford 

41°46' 

102,727 

494,572 

492 

99.5 

41°30' 

596,443 

2,803,315 

1,960 

69.9 

New  Haven 

41°19' 

138,721 

128,404 

668,025 
620,478 

616 

538 

92.2 

41°16' 

86.7 

Constantinople 

41°  0' 

1,200,000 

5,750,000 

2,001 

34.8 

40°51' 

689,480 

3,332,910 

2,168 

65.0 

Newark 

40°45' 

373,141 

1,737,345 

1,313 

75.6 

40°44' 

72,268 

351,621 

283 

80.5 

Jersey  City 

40°43' 

281,811 
5,032,821 

1,338,895 
23,834,415 

833 
18,385 

62.2 

40°43' 

77.1 

Pittsburgh 

40°26' 

550,385 

2,669,525 

1,773 

66.4 

Madrid 

40°24' 

578,000 

2,825,985 

2,673 

94.6 

Columbus 

40°  0' 

192,701 

907,553 

823 
121,216 

90.7 

Total 

27,519,705 

131,256,257 

92.4 

404 


APPENDIX  E 

Table  1  (continued) 
Mortality  from  Cancer  in  Large  Cities,  according  to  Latitude 

1908-1912 


LATITUDE  40°  N.-30°  N. 

Latitude  Population  Total 

City  North  1912  Population 

Philadelphia 39°57'  1,600,072  7,745,040 

Dayton             39°44'  122,825  582,882 

Denver                 39°41'  229,287  1,066,905 

Indianapolis 39°40'  246,546  1,168,247 

Baltimore 39°17'  568,391  2,792,425 

Kansas  City,  Mo 39°  8'  265,306  1,241,903 

Washington 38°53'  341,541  1,655,346 

St  Louis         38°38'  709,387  3,435,143 

Lo'uis\dlle 38°12'  227,766  1,119,637 

Cincinnati 38°  8'  371,129  1,817,955 

Palermo                        38°  7'  344,227  1,689,745 

Athens          37°58'  188,130  816,750 

San  Francisco 37°48'  431,738  2,084,560 

Richmond 37°32'  136,144  638,140 

Nash\'ille     36°  9'  116,264  551,820 

Gibraltar 36°  7'  19,017  97,823 

Tokio                                  ...  35°39'  1,860,000  8,132,879 

Memphis    35°  8'  136,861  655,522 

Kyoto                           35°  1'  490,000  2,216,496 

Osaka                               ....  34°44'  1,260,000  6,014,365 

Los  Angeles 34°  5'  362,541  1,595,988 

Augusta            33°33'  41,360  205,200 

Charleston 32°46'  59,437  294,162 

Savannah,  Ga 32°  5'  67,228  325,320 

Total 10,195,197  47,944,253 

LATITUDE  30°  N.-10°  N. 

New  Orleans 29°58'  349,471  1,695,376 

Havana     23°  9'  353,509  1,644,513 

Calcutta 22°34'  900,894  4,456,200 

Hongkong 22°18'  368,420  1,777,706 

Mexico  City 19°26'  491,500  2,355,330 

Manila        14°35'  241,653  1,172,043 

Caracas 10°31'  75,000  375,000 

Total 2,780,447  13,476,168 

LATITUDE  10°  N.-10°  S. 

Paramaribo 5°49'  35,000 

Bogota 4°35'  121,257 

Singapore 1°17'  323,373 

Guayaquil S.  2°11'  80,000 

Total 559,630  2,583,495 


Deaths 

from 
Cancer 

Rate  per 

100,000 

Population 

6,610 
525 

85.3 
90.1 

887 

83.1 

947 

81.1 

2,500 
981 

89.5 
79.0 

1,455 

2,815 
764 

87.9 
81.9 
68.2 

1,680 
892 

92.4 
52.8 

543 

66.5 

2,287 
518 

109.7 
81.2 

377 

68.3 

81 

82.8 

5,918 
333 

72.8 
50.8 

1,968 

3,281 

1,610 

124 

88.8 

54.6 

100.9 

60.4 

173 

58.8 

182 

55.9 

37,451 


5,696 


78.1 


1,440 

84.9 

1,689 

102.7 

522 

11.7 

157 

8.8 

1,165 

49.5 

330 

28.2 

393 

104.8 

42.3 


174,775 

167 

95.6 

607,465 

545 

89.7 

1,521,255 

177 

11.6 

280,000 

167 

59.6 

1,056 


40.9 


405 


APPENDIX  E 

Table  1  (concluded) 
Mortality  from  Cancer  in  Large  Cities,  according  to  Latitude 

1908-1912 


LATITUDE,  10°S.-30°S. 

Latitude  Population 

City                                                    South  1912 

Bahia 13°  0'  300,000 

La  Paz 16°30'  86,926 

Bello  Horizonte 20°  0'  39,845 

Rio  de  Janeiro 22°54'  710,600 

Sao  Paulo 23°38'  400,000 

Johannesburg 26°26'  249,000 

Santiago  del  Estero 27°48'  20,580 

Total 1,806,951 

LATITUDE,  30°S.-40°S. 

Pelotas 31°50'  38,207 

Rosario  de  Santa  Fe 33°  0'  225,600 

Sydney 33°52'  675,800 

Buenos  Aires 34°36'  1,383,663 

Montevideo 34°54'  355,017 

Total 2,678,287       12,297,218 


Deaths 

Rale  per 

Total 

from 

100,000 

Population 

Cancer 

Population 

1,413,800 

328 

23.2 

316,090 

69 

21.8 

112,280 

41 

36.5 

3,357,032 

1,427 

42.5 

1,694,000 

769 

45.4 

1,076,862 

370 

34.4 

96,080 

36 

37.5 

8,066,144 


3,040 


37.7 


181,201 

147 

81.1 

937,604 

684 

73.0 

3,114,640 

2,805 

90.1 

6,406,275 

5,475 

85.5 

1,657,498 

1,937 

116.9 

11,048 


406 


APPENDIX  E 


Table  2 

Mortality  from  Cancer  in  Large  Cities  of  the  Eastern  and  Western 

Hemispheres,  according  to  Latitude 

1908-1912 


LATITUDE,  50°N.-40°N.,  EASTERN  HEMISPHERE 


Latitude 

City  North 

Le  Havre 49°29' 

Nuremberg 49°27' 

Paris 48°50' 

Nancy 48°40' 

Vienna 48°14' 

Munich 48°  9' 

Basel 47°34' 

Budapest 47°29' 

Zurich 47°23' 

Berne 46°57' 

Geneva 46°12' 

Lyon 45°42' 

Milan 45°28' 

Turin 45°  4' 

Bordeaux 44°50' 

Genoa 44°24' 

Florence 43°45' 

Nice 43°43' 

Rome 41°54' 

Constantinople 41°  0' 

Naples 40°51' 

Madrid 40°24' 

Total 

LATITUDE,  50°  N.-40° 

Winnipeg 49°56' 

Seattle 47°36' 

Quebec 46°48' 

Montreal 4o°30' 

St.  John 45°14| 

Minneapolis 44°o8 

St.  Paul 44°52' 

Toronto 43W 

Rochester 43    8 

Milwaukee 43°  3' 

Buffalo 42°53' 

Boston 42°22' 

Detroit 42°20' 

SpringBeld,  Mass 42°  6' 

Chicago 41°53'^ 

Providence 41°50' 

Hartford 41°46' 

Cleveland 41°30' 

New  Haven 41°19' 

Omaha 41°16' 

Newark 40°45' 

Hoboken 40°44^ 

Jersey  City 40  43 

Greater  New  York 40°43' 

Pittsburgh 40°26' 

Columbus 40°  0' 

Total 


Population 
191^2 

136,905 
345,416 

2,872,400 
121,688 

2,077,295 
615,000 
135,632 
905,244 
199,000 
86,900 
130,000 
534,132 
609,974 
436,251 
263,624 
275,972 
235,587 
144,682 
550,057 

1,200,000 
689,480 
578,000 

13.143,239 

N.,  WESTERN 

159,256 

268,500 

79,300 
484,400 

42,691 
321,146 
221,832 
414,000 
232,741 
398,219 
442,567 
715,711 
515,156 

94,300 
2,282,623 
234,602 
102,727 
596,443 
138,721 
128,404 
373,141 

72,268 

281,811 

5,032,821 

550,385 

192,701 


Total 
Population 

677,065 

1,649,630 

14,111,481 

591,050 

10,064,070 

2,951,000 

657,827 
4,337,060 

945,026 

417,323 

621,646 
2,618,980 
2,942,130 
2,089,805 
1,042,820 
1,342,350 
1,150,665 

710,345 
2,670,945 
5,750,000 
3,332,910 
2,825,985 

63,500,113 
HEMISPHERE 

715,250 
1,185,970 

379,013 
2,185,680 

211,655 
1,507,040 
1,073,718 
1,819,052 
1,090,742 
1,869,282 
2,118,575 
3,352,926 
2,328,827 

444,630 

10,926,412 

1,121,628 

494,572 
2,803,315 

668,025 

620,478 
1,737,345 

351,621 

1,338,895 

23,834,415 

2,669,525 

907,553 


Deaths 
from 
Cancer 

917 

1,721 

15,638 

705 

12,971 

4,936 

752 
4,450 
1,053 

446 

766 
3,908 
3,562 
2,341 
1,184 
1,393 
1,861 

710 
2,679 
2,001 
2,168 
2,673 

68,835 

362 

662 

209 
1,429 

173 
1,052 

802 
1,313 

996 
1,292 
1,879 
3,545 
1,528 

407 
8,618 
1,098 

492 
1,960 

616 

538 
1,313 

283 

833 

18,385 

1,773 

823 


Rate  per 

100,000 

Population 

135.4 
104.3 
110.8 
119.3 
128.9 
167.3 
114.3 
102.6 
111.4 
106.9 
123.2 
149.2 
121.1 
112.0 
113.5 
103.8 
161.7 
99.8 
100.3 
34.8 
65.0 
94.6 

108.4 

50.6 
55.8 
55.1 
65.4 
81.7 
69.8 
74.7 
72.2 
91.3 
69.1 
88.7 
105.7 
65.6 
91.5 
78.9 
97.9 
99.5 
69.9 
92.2 
86.7 
75.6 
80.5 
62.2 
77.1 
66.4 
90.7 


14,376,466   67,756,144    52,381     77.3 


407 


APPENDIX  E 

Table  2  (continued) 

Mortality  from  Cancer  in  Large  Cities  of  the  Eastern  and  Western 

Hemispheres,  according  to  Latitude 

1908-1912 


LATITUDE,  40°N.-30°N.,  EASTERN  HEMISPHERE 


City 
Palermo.  . 

Athens 

Gibraltar. . 

Tokio 

Kyoto .... 
Osaka. . . . 


Deaths 

Rate  per 

Latitude 

Population 

Total 

from 

100,000 

North 

1912 

Population 

Cancer 

Population 

38°  7' 

344,227 

1,689,745 

892 

52.8 

37°58' 

188,130 

816,750 

543 

66.5 

36°  7' 

19,017 

97,823 

81 

82.8 

35°39' 

1,860,000 

8,132,879 

5,918 

72.8 

35°  1' 

490,000 

2,216,496 

1,968 

88.8 

34°44' 

1,260,000 

6,014,365 

3,281 

54.6 

Total. 


4,161,374       18,968,058         12,683 


LATITUDE,  40'='N,-30°N.,  WESTERN  HEMISPHERE 


Philadelphia 

Dayton 

Denver 

Indianapolis 

Baltimore 

Kansas  City,  Mo. 

Washington 

St.  Louis 

Louisville 

Cincinnati 

San  Francisco . . . . 

Richmond 

Nashville 

Memphis 

Los  Angeles 

Augusta 

Charleston 

Savannah,  Ga 


Total. 


Calcutta.  . 
Hongkong. 
Manila 


Total. 


New  Orleans. 

Havana 

Mexico  City. 
Caracas 


6,033,823       28,976,195 

LATITUDE,  30°N.-10°N.,  EASTERN  HEMISPHERE 


22°34' 
22°18' 
14°35' 


900,894 
368,420 
241,653 


4,456,200 
1,777,706 
1,172,043 


LATITUDE,  30°N.-10° 

29°58' 

23°  9' 

19°26' 

10°31' 


1,510,967         7,405,949 
WESTERN  HEMISPHERE 


349,471 

353,509 

491,500 

75,000 


1,695,376 

1,644,513 

2,355,330 

375,000 


Total. 


1,269,480    6,070,219 


24,768 


157 
330 

1,009 


1,440 

1,689 

1,165 

393 

4,087 


66.9 


39°57' 

1,600,072 

7,745,040 

6,610 

85.3 

39°44 

122,825 

582,882 

525 

90.1 

39°41' 

229,287 

1,066,905 

887 

83.1 

39°40' 

246,546 

1,168,247 

947 

81.1 

39°17 

568,391 

2,792,425 

2,500 

89.5 

39°  8 

265,306 

1,241,903 

981 

79.0 

38°53 

341,541 

1,655,346 

1,455 

87.9 

38°38 

709,387 

3,435,143 

2,815 

81.9 

38°12' 

227,766 

1,119,637 

764 

68.2 

38°  8' 

371,129 

1,817,955 

1,680 

92.4 

37°48' 

431,738 

2,084,560 

2,287 

109.7 

37^32' 

136,144 

638,140 

518 

81.2 

36°  9' 

116,264 

551,820 

377 

68.3 

35°  8' 

136,861 

655,522 

333 

50.8 

34°  5 

362,541 

1,595,988 

1,610 

100.9 

33°33' 

41,360 

205,200 

124 

60.4 

32°46' 

59,437 

294,162 

173 

58.8 

32°  5' 

67,228 

325,320 

182 

55.9 

85.5 

11.7 

8.8 

28.2 

13.6 


84.9 
102.7 

49.5 
104.8 

77.2 


408 


APPENDIX  E 

Table  2  (concluded) 

Mortality  from  Cancer  in  Large  Cities  of  the  Eastern  and  Western 

Hemispheres,  according  to  Latitude 

1908-1912 


Deaths  Rate  per 

from  100,000 

Cancer  Population 

177  11.6 


167 
545 
167 

879 


370 


2,670 


2,805 


95.6 
89.7 
59.6 

82.7 


34.4 


LATITUDE,  lO-N.-lO-S.,  EASTERN  HEMISPHERE 

Latitude  Population  Total 

City  North  1912  Population 

Singapore 1°17'  323,373         1,521,255 

LATITUDE,  10°N.-10°S.,  WESTERN  HEMISPHERE 

Paramaribo 5°49'  35,000  174,775 

Bogota 4°35'  121,257  607,465 

Guayaquil S.  2°11'  80,000  280,000 

Total 236,257         1,062,240 

LATITUDE,  10°  8.-30°  S.,  EASTERN  HEMISPHERE 
Johannesburg 26°26'  249,000         1,076,862 

LATITUDE,  10°S.-30°S.,  WESTERN  HEMISPHERE 

Bahia 13°  0'  300,000  1,413,800 

La  Paz 16°30'  86,926  316,090 

Bello  Horizonte 20°  0'  39,845  112,280 

Rio  de  Janeiro 22°54'  710,600  3,357,032 

Sao  Paulo 23°38'  400,000  1,694,000 

Santiago  del  Estero 27°48'  20,580  96,080 

Total 1,557,951         6,989,282 

LATITUDE,  30°S.-40°S.,  EASTERN  HEMISPHERE 
Sydney 33°52'  675,800         3,114,640 

LATITUDE,  30°S.-40°S.,  WESTERN  HEMISPHERE 

Pelotas 31°50'  38,207  181,201 

Rosario  de  Santa  Fe 33°  0'  225,600  937,604 

Buenos  Aires 34°36'  1,383,663  6,406,275 

Montevideo 34°54'  355,017  1,657,498 

Total 2,002,487         9,182,578 


328 

23.2 

69 

21.8 

41 

36.5 

1,427 

42.5 

769 

45.4 

36 

37.5 

38.2 


90.1 


147 

81.1 

684 

73.0 

5,475 

85.5 

1,937 

116.9 

8,243 


89.8 


409 


APPENDIX  E 

Table  3 
Mortality  from  Cancer  in  Cities,  according  to  Size,  1908-1912 

Rate  per 
No.  of  Population  Total  Deaths  from  100,000 

Cities  1912  Population  Cancer  Population 

14  1,000,000  and  over  30,872,254  147,889,255  137,531  93.0 

26  500,000-  1,000,000  17,049,274  78,667,982  74,482  94.7 
41  250,000-     500,000  14,858,442  70,138,157  58,804  83.8 

27  125,000-     250,000  5,140,049  24,367,754  21,946  90.1 
22  Less  than  125,000  1,600,284  7,473,062  6,118  81.9 


130  69,520,303  328,536,210  298,881  91.0 

Cities  with  1,000,000  Population  and  Over 

1  Greater  New  York 5,032,821  23,834,415  18,385  77.1 

2  London 4,531,572  22,671,154  25,322  111.7 

3  Paris 2,872,400  14,111,481  15,638  110.8 

4  Chicago 2,282,623  10,926,412  8,618  78.9 

5  BerUn 2,100,000  10,361,160  13,831  133.5 

6  Vienna 2,077,295  10,064,070  12,971  128.9 

7  Petrograd 1,990,874  9,815,760  8,400  85.6 

8  Tokio 1,860,000  8,132,879  5,918  72.8 

9  Moscow 1,617,733  7,050,000  5,805  82.3 

10  Philadelphia 1,600,072  7,745,040  6,610  85.3 

11  Buenos  Aires 1,383,663  6,406,275  5,475  85.5 

12  Osaka 1,260,000  6,014,365  3,281  54.6 

13  Constantinople 1,200,000  5,750,000  2,001  34.8 

14  Hamburg 1,063,201  5,006,244  5,276  105.4 

Total 30,872,254  147,889,255  137,531  93.0 

Cities  with  500,000  to  1,000,000  Population 

1  Budapest 905,244  4,337,060  4,450  102.6 

2  Calcutta 900,894  4,456,200  522  11.7 

3  Glasgow 785,600  3,918,239  4,190  106.9 

4  Birmingham 850,947  2,951,231  2,592  87.8 

5  Liverpool 752,021  3,716,551  3,592  96.6 

6  Manchester 724,168  3,460,469  3,321  96.0 

7  Boston 715,711  3,352,926  3,545  105.7 

8  Rio  de  Janeiro 710,600  3,357,032  1,427  42.5 

9  St.  Louis 709,387  3,435,143  2,815  81.9 

10  Naples 689,480  3,332,910  2,168  65.0 

11  Sydney 675,800  3,114,640  2,805  90.1 

12  Brussels 646,400  891,295  939  105.4 

13  Munich 615,000  2,951,000  4,936  167.3 

14  Milan 609,974  2.942,130  3,562  121.1 

15  Leipzig 605,755  2,848,078  2,817  98.9 

16  Cleveland 596,443  2,803,315  1,960  69.9 

17  Amsterdam 588,000  2,874,663  3,355  116.7 

18  Madrid 578,000  2,825,985  2,673  94.6 

19  Copenhagen 570,000  2,744,628  4,427  161.3 

20  Baltimore 568,391  2,792,425  2,500  89.5 

21  Dresden 557,400  2,727,750  3,594  131.8 

22  Pittsburgh 550,385  2,669,525  1,773  66.4 

23  Rome 550,057  2,670,945  2,679  100.3 

24  Cologne 544,329  2,546,035  2,404  94.4 

25  Lyon 534,132  2,618,980  3,908  149.2 

20  Detroit 515,156  2,328,827  1,528  65.6 

Total 17,049,274  78,667,982  74,482  94.7 


410 


APPENDIX  E 

Table  3  (continued) 
Mortality  from  Cancer  in  Cities,  according  to  Size,  1908-1912 


Cities  with  250,000  to  500,000  Population 

Population  Total 

City  1912  Population 

1  Mexico  City 491,500  2,355,330 

2  Kyoto 490,000  2,216,496 

3  Montreal 484,400  2,185,680 

4  Sheffield 466,408  2,261,241 

5  Leeds 447,746  2,221,718 

0  Rotterdam 445,137  2,137,458 

7  Buffalo 442,567  2,118,575 

8  Turin 436,251  2,089,805 

9  San  Francisco 431,738  2,084,560 

10  Frankfurt  a/M 428,500  1,982,500 

11  Toronto 414,000  1,819,052 

12  Sao  Paulo 400,000  1,694,000 

13  Milwaukee 398,219  1,869,282 

14  Belfast 390,724  1,915,845 

15  Newark 373,141  1,737,345 

16  Cincinnati 371,129  1,817,955 

17  Hongkong 368,420  1,777,706 

18  Los  Angeles 362,541  1,595,988 

19  Bristol 359,400  1,784,270 

20  Monte\adeo 355,017  1,657,498 

21  Havana 353,509  1,644,513 

22  New  Orleans 349,471  1,695,376 

23  Stockholm 346,848  1,712,593 

24  Nuremberg 345,416  1,649,630 

25  Palermo 344,227  1,689,745 

26  Washington 341,541  1,655,346 

27  Singapore 323,373  1,521,255 

28  Antwerp 322,275  1,554,689 

29  Minneapolis 321,146  1,507,040 

30  Edinburgh 321,119  1,602,543 

31  Bremen 316,000  1,484,152 

32  Dublin 306,218  1,516,918 

33  Essen 305,024  1,414,452 

34  Bahia 300,000  1,413,800 

35  The  Hague 294,540  1,375,718 

36  Jersey  City 281,811  1,338,895 

37  Genoa 275,972  1,342,350 

38  Seattle 268,500  1,185,970 

39  Kansas  City,  Mo 265,306  1,241,903 

40  Bordeaux 263,624  1,042,820 

41  Konigsberg 255,684  1,226,145 

Total 14,858,442  70,138,157 


Rate  per 

Deaths  from 

100,000 

Cancer 

Population 

1,165 

49.5 

1,968 

88.8 

1,429 

65.4 

1,894 

83.8 

2,308 

103.9 

1,980 

92.6 

1,879 

88.7 

2,341 

112.0 

2,287 

109.7 

1,850 

93.3 

1,313 

72.2 

769 

45.4 

1,292 

69.1 

1,612 

84.1 

1,313 

75.6 

1,680 

92.4 

157 

8.8 

1,610 

100.9 

1,792 

100.4 

1,937 

116.9 

1,689 

102.7 

1,440 

84.9 

2,047 

119.5 

1,721 

104.3 

892 

52.8 

1,455 

87.9 

177 

11.6 

1,376 

88.5 

1,052 

69.8 

1,918 

119.7 

1,546 

104.2 

1,701 

112.1 

856 

60.5 

328 

23.2 

1,490 

108.3 

833 

62.2 

1,393 

103.8 

662 

55.8 

981 

79.0 

1,184 

113.5 

1,487 

121.3 

58,804 


83.8 


411 


APPENDIX  E 

Table  3  (concluded) 

Mortality  from  Cancer  in  Cities,  according  to  Size,  1908-1912 

Cities  with  125,000  to  250,000  Population 


Population  Total                 Deaths  from 

City  1912  Population  Cancer 

1  Johannesburg 249,000  1,076,862  370 

2  Indianapolis 246,546  1,168,247  947 

3  Kristiania 243,967  1,205,625  1,229 

4  Manila 241,653  1,172,043  330 

5  Florence 235,587  1,150,665  1,861 

6  Pro^-idence 234,602  1,121,628  1,098 

7  Rochester 232,741  1,090,742  996 

8  Denver 229,287  1,066,905  887 

9  Loms\alle 227,766  1,119,637  764 

10  Rosario  de  Santa  Fe 225,600  937,604  684 

11  St.  Paul 221,832  1,073,718  802 

12  LQle 220,243  1,076,849  1,469 

13  Zurich 199,000  945,026  1,053 

14  Columbus 192,701  907,553  823 

15  Athens 188,130  816,750  543 

16  Goteborg 172,006  821,817  759 

17  Liege 167,851  837,517  878 

18  Aberdeen 164,932  814,268  941 

19  Winnipeg 159,256.  715,250  362 

20  Nice 144,682  710,345  710 

21  New  Haven 138,721  668,025  616 

22  Le  Ha\Te 136,905  677,065  917 

23  Memphis 136,861  655,522  333 

24  Richmond 136,144  638,140  518 

25  Basel 135,632  657,827  752 

26  Geneva 130,000  621,646  766 

27  Omaha 128,404  620,478  538 

Total 5,140,049  24,367,754  21,946 

Cities  with  Less  Than  125,000  Population 

1  Dayton 122,825  582,882  525 

2  Nancy 121,688  591,050  705 

3  Bogota 121,257  607,465  545 

4  Nash\alle 116,264  551,820  377 

5  Hartford 102,727  494,572  492 

6  Springfield,  Mass 94,300  444,630  407 

7  La  Paz 86,926  316,090  69 

8  Bern 86,900  417,323  446 

9  Guayaquil 80,000  280,000  167 

10  Quebec 79,300  379,013  209 

11  Bergen 77,464  383,100  376 

12  Caracas 75,000  375,000  393 

13  Hoboken 72,268  351,621  283 

14  Savannah 67,228  325,320  182 

15  Charleston 59,437  294,162  173 

16  St.  John 42,691  211,655  173 

17  Augusta,  Ga 41,360  205,200  124 

18  BelloHorizonte 39,845  112,280  41 

19  Pelotas 38,207  181,201  147 

20  Paramaribo 35,000  174,775  167 

21  Santiago  del  Estero 20,580  96,080  36 

22  Gibraltar 19,017  97.823  81 

Total 1,600,284  7,473,062  6,118 


Rate  per 

100,000 

Population 

34.4 

81.1 

101.9 

28.2 

161.7 

97.9 

91.3 

83.1 

68.2 

73.0 

74.7 

136.4 

111.4 

90.7 

66.5 

91.2 

104.8 

115.6 

50.6 

99.8 

92.2 

135.4 

50.8 

81.2 

114.3 

123.2 

86.7 

90.1 


90.1 
119.3 
89.7 
68.3 
99.5 
91.5 
21.8 
106.9 
59.6 
55.1 
98.1 
104.8 
80.5 
55.9 
58.8 
81.7 
60.4 
36.5 
81.1 
95.6 
37.5 
82.8 

81.9 


412 


APPENDIX  E 

Table  4 

Comparative  Mortality  from  Cancer,  by  Organs  and  Parts 

in  Thirteen  Principal  Countries  of  the  World 


Australian  Commonwealth,   1908-1912 

Deaths  Rate  per 

from  100,000 

Cancer        Population 

Stomach  and  Liver 6,024  27.4 

Skin 503  2.3 

Rate  per 

100,000 

Female 

Population 

Female  generative  organs 1,635  15.6 

Female  breast 1.117  10.6 

Total  population 21,997,568 

Female  population 10,573,554 

General  cancer  death  rate 73.2 


Bavaria,  1905-1910 

Deaths  Rate  per 

from  100,000 

Cancer  Population 

Stomach  and  liver 23,911  59.4 

Skin 311  0.8 

Rate  per 

100,000 

Female 

Population 

Female  generative  organs 4,434  21.6 

Female  breast l,S1\  9.1 

Total  population 40,234,987 

Female  population 20,507,907 

General  cancer  death  rate 109.4 


Cuba,  1908-1912 

Deaths  Rate  per 

from  100,000 

Cancer         Population 

Stomach  and  liver 1,383  12.7 

Skin 215  2.0 

Rate  per 

100,000 

Female 

Population 

Female  generative  organs 973  18.9 

Female  breast 232  4.5 

Total  population 10,892,077 

Female  population 5,157,276 

General  cancer  death  rate 44.6 


413 


APPENDIX  E 

Table  4  (continued) 

Comparative  Mortality  from  Cancer,  by  Organs  and  Parts 

in  Thirteen  Principal  Countries  of  the  World 


England  and  Wales,  1906-1910 

Deaths  Rate  per 

from  100,000 

Cancer  Population 

Stomach  and  liver 55,105  31.4 

Skin 3,731  2.1 

Rate  per 

100,000 

Female 

Population 

Female  generative  organs 21,908  24.2 

Female  breast 16,185  17.9 

Total  population 175,333,013 

Female  population 90,535,741 

General  cancer  death  rate 94.0 


Holland,  1906-1910 

Deaths  Rate  per 

from  100,000 

Cancer  Population 

Stomach  and  liver 17,878  62.2 

Skin . 411  1.4 

Rate  per 

100,000 

Female 

Population 

Female  generative  organs 1,919  13.2 

Female  breast 1,390  9.6 

Total  population 28,725,355 

Female  population 14,506,305 

General  cancer  death  rate 103.5 


Ireland,  1906-1910 

Deaths  Rate  per 

from  100,000 

Cancer         Population 

Stomach  and  liver 6,795  31.0 

Skin 589  2.7 

Rate  per 
100,000 
Female 

Population 

Female  generative  organs 1,415  12.8 

Female  breast 1,545  14.0 

Total  population 21,942,708 

Female  population 11,012,089 

General  cancer  death  rate 78.8 


414 


APPENDIX  E 

Table  4  (continued) 

Comparative  Mortality  from  Cancer,  by  Organs  and  Parts 

in  Thirteen  Principal  Countries  of  the  World 


Italy,  1906-1910 

Deaths  Rate  per 

from  100,000 

Cancer         Population 

Stomach  and  liver 44,330  26.2 

Skin 

Rate  per 

100,000 

Female 

Population 

Female  generative  organs 13,741  16.0 

Female  breast 5,019  5.8 

Total  population 169,081,524 

Female  population 85,896,061 

General  cancer  death  rate 63.6 


Japan,  1909-1910 

Deaths  Rate  per 

from  100,000 

Cancer  Population 

Stomach  and  liver 39,861  40.0 

Skin 734  0.7 

Rate  per 

100,000 

Female 

Population 

Female  generative  organs 10,322  20.9 

Female  breast 878  1.8 

Total  population 99,728,840 

Female  population 49,505,396 

General  cancer  death  rate 65.5 


Norway,  1906-1910 

Deaths  Rate  per 

from  100,000 

Cancer         Population 

Stomach  and  liver 7,130  61.4 

Skin 

Rate  per 

100,000 

Female 

Population 

Female  generative  organs 692  11.5 

Female  breast 440  7.3 

Total  population 11,606,600 

Female  population 5,993,116 

General  cancer  death  rate 96.6 


415 


APPENDIX  E 

Table  4  (continued) 

Comparative  Mortality  from  Cancer,  by  Organs  and  Parts 

in  Thirteen  Principal  Countries  of  the  World 


Scotland,  1906-1910 

Deaths  Rate  per 

from  100,000 

Cancer        Population 

Stomach  and  liver 8,417  36.0 

Skin 396  1.7 

Rate  per 

100,000 

Female 

Population 

Female  generative  organs 2,479  20.6 

Female  breast 1,856  15.4 

Total  population 23,394,061 

Female  population 12,047,942 

General  cancer  death  rate 99.7 


Switzerland,  1906-1910 

Deaths  Rate  per 

from  100,000 

Cancer  Population 

Stomach  and  liver 12,838  70.4 

Skin 344  1.9 

Rate  per 

100,000 

Female 

Population 

Female  generative  organs 1,995  21.4 

Female  breast 1,264  13.6 

Total  population 18,237,395 

Female  population 9,301,072 

General  cancer  death  rate 125.9 


Uruguay,  1906-1910 

Deaths  Rate  per 

from  100,000 

Cancer        Population 

Stomach  and  liver 1,880  35.6 

Skin 57  1.1 

Rate  per 

100,000 

Female 

Population 

Female  generative  organs ■. . . .  317  12.2 

Female  breast 96  3.7 

Total  population 5,277,942 

Female  population 2,592,524 

General  cancer  death  rate 66.0 


416 


APPENDIX  K 

Table  4  (concluded) 

Comparative  Mortality  from  Cancer,  by  Organs  and  Parts 

in  Thirteen  Principal  Countries  of  the  World 


United  States  Registration  Area,  1906-1910 

Deaths  Rate  per 

from  100,000 

Cancer  Population 

Stomach  and  liver 66,976  28.3 

Skin 6,338  2.7 

Rate  per 

100,000 

Female 

Population 

Female  generative  organs 25,589  22.1 

Female  breast 15.349  13.3 

Total  population 236,504,736 

Female  population 115,779,973 

General  cancer  death  rate 72.6 


417 


APPENDIX 

F 

PART  I 

Cancer  Mortality  Statistics  of  the  United  States 
Registration  Area 

Table  Page 

1  Estimated  Mortality  from  Cancer,  Continental  United  States,  1900-1913 422 

2  Mortality  from  Cancer,  United  States  Registration  Area,  1900-1913 422 

3  Mortality  from  Cancer,  United  States  Registration  States,  1900-1913.  .  . 422 

4  Mortality  from  Cancer,  United  States  Registration  Cities,  1900-1913 422 

5  Mortality  from  Cancer,  California,  1906-1913 422 

6  Mortality  from  Cancer,  Colorado,  1906-1913 422 

7  Mortality  from  Cancer,  Connecticut,  1900-1913 423 

8  Mortality  from  Cancer,  Indiana,  1900-1913 423 

9  Mortality  from  Cancer,  Kentucky,  1911-1913 423 

10  Mortality  from  Cancer,  Maine,  1900-1913 423 

11  Mortality  from  Cancer,  Maryland,  1906-1913 423 

12  Mortality  from  Cancer,  Massachusetts,  1900-1913 423 

13  Mortality  frotai  Cancer,  Michigan,  1900-1913 424 

14  Mortality  from  Cancer,  Minnesota,  1910-1913 424 

15  Mortality  from  Cancer,  Missouri,  1911-1913 424 

16  Mortality  from  Cancer,  Montana,  1910-1913 424 

17  Mortality  from  Cancer,  New  Hampshire,  1900-1913 424 

18  Mortality  from  Cancer,  New  Jersey,  1900-1913 425 

19  Mortality  from  Cancer,  New  York,  1900-1913 425 

20  Mortality  from  Cancer,  North  Carolina,  1910-1913 425 

21  Mortality  from  Cancer,  Ohio,  1909-1913 425 

22  Mortality  from  Cancer,  Pennsylvania,  1906-1913 425 

23  Mortality  from  Cancer,  Rhode  Island,  1900-1913 426 

24  Mortality  from  Cancer,  South  Dakota,  1906-1909 426 

418 


APPENDIX  F  {PART  I) 

Table  Page 

25  Mortality  from  Cancer,  Utah,  1910-1913 426 

26  Mortality  from  Cancer,  Vermont,  1900-1913 426 

27  Mortality  from  Cancer,  Washington,  1908-1913 426 

28  Mortality  from  Cancer,  Wisconsin,  1908-1913 426 

29  Estimated  Mortality  from  Malignant  and  Benign  Tumors,  Continental  United 

States,  1900-1913 427 

30  Estimated  Mortality  from  Benign  Tumors,  Continental  United  States,  1900- 

1913 427 

31  Mortality  from  Cancer,  United  States  Registration  Area,  Males,  1900-1913 427 

32  Mortality  from  Cancer,  United  States  Registration  Area,  Females,  1900-1913 .  .  .     427 

33  Mortality  from  Benign  Tumors,  United  States  Registration  Area,  1900-1913 ....     428 

34  Mortality  from  Benign  Tumors,  United  States  Registration  Area,  Males,  1900- 

1913 428 

35  Mortality  from  Benign  Tumors,  United  States  Registration  Area,   Females, 

1900-1913 429 

36  Mortality  from  Ulcer  of  Stomach,  by  Sex,  United  States  Registration  Area, 

1900-1913 429 

37  Mortality  from  Biliary  Calculi,  by  Sex,  United  States  Registration  Area,  1900- 

1913 430 

38  Mortality  from  Calculi  of  the  Urinary  Tract,  by  Sex,  United  States  Registra- 

tion Area,  1900-1913 430 

39  Mortality  from  Cancer,  by  Race,  United  States  Registration  Area,  1910-1912.  .  .     431 

40  Mortality  from  Cancer,  Urban  and  Rural,  United  States  Registration  States, 

1900-1913 431 

41  Mortality  from  Cancer  of  the  Buccal  Cavity,  by  Sex,  United  States  Registra- 

tion Area,  1900-1913 432 

42  Mortality  from  Cancer  of  the  Stomach  and    Liver,  by  Sex,    United    States 

Registration  Area,  1900-1913 432 

43  Mortality  from  Cancer  of  the  Peritoneum,  Intestines  and  Rectum,  by  Sex, 

United  States  Registration  Area,  1900-1913 433 

44  Mortality  from  Cancer  of  the  Female  Generative  Organs  and  Female  Breast, 

United  States  Registration  Area,  1900-1913 433 

45  Mortality  from  Cancer  of  the  Skin,  by  Sex,  United  States  Registration  Area, 

1900-1913 434 

46  Mortality  from  Cancer  of  Other  or  Not  Specified  Organs  and  Parts,  by  Sex, 

United  States  Registration  Area,  1900-1913 434 

47  Estimated  Mortality  from  Cancer,  by  Organs  and  Parts,  Continental  United 

States,  1900-1913 435 

48  Population  Statistics,  by  Age  and  Sex,  United  States  Registration  Area,  1903- 

1912 435 

419 


APPENDIX  F  {PART  I) 

Table  Page 

49  Mortality  from  Cancer,  by  Age  and  Sex,  United  States  Registration  Area,  1903- 

•1912 436 

50  Mortality  from  Cancer  of  the  Buccal  Cavity,  by  Age  and  Sex,  United  States 

Registration  Area,  1903-1912 436 

51  Mortality  from  Cancer  of  the  Stomach  and  Liver,  by  Age  and  Sex,  United  States 

Registration  Area,  1903-1912 437 

52  Mortality  from  Cancer  of  the  Peritoneum,  Intestines  and  Rectum,  by  Age  and 

Sex,  United  States  Registration  Area,  1903-1912 437 

53  Mortality  from  Cancer  of  the  Female  Generative  Organs  and  Female  Breast,  by 

Age,  United  States  Registration  Area,  1903-1912 438 

54  Mortality  from  Cancer  of  the  Skin,  by  Age  and  Sex,  United  States  Registration 

Area,  1903-1912 438 

55  Mortality  from  Cancer  of  Other  or  Not  Specified  Organs  and  Parts,  by  Age 

and  Sex,  United  States  Registration  Area,  1903-1912 439 

56  Mortality  from  Cancer,  Urban  and  Rural,  by  Organs  and  Parts,  United  States 

Registration  States,  1908-1912 439 

57  Proportion  of  Mortality  from  Cancer  to  All  Causes,  by  Age  and  Sex,  United 

States  Registration  Area,  1908-1912 440 

58  Mortality  from  Cancer  and  Other  Important  Causes  of  Death,  by  Age  and  Sex, 

United  States  Registration  Area,  1908-1912 440 

59  Mortality  from  Cancer,  by  Months,  New  York,  Massachusetts,  New  Hampshire 

and  Connecticut,  1902-1911 441 

60  Comparative  Cancer  Death  Rate,  by  Age  and  Sex,  United  States  Registration 

Area,  1901-1911 442 

61  Mortality  from  Cancer,  by  Age,  Males,  United  States  Registration  Area,  1903- 

1907  Compared  with  1908-1912 443 

62  Mortality  from  Cancer,  by  Age,  Females,  United  States  Registration  Area, 

1903-1907  Compared  with  1908-1912 443 

63  Mortality  from  Cancer  of  the  Buccal  Cavity,  by  Age,  Males,  United  States 

Registration  Area,  1903-1907  Compared  with  1908-1912 444 

64  Mortality  from  Cancer  of  the  Buccal  Cavity,  by  Age,  Females,  United  States 

Registration  Area,  1903-1907  Compared  with  1908-1912 444 

65  Mortality  from  Cancer  of  the  Stomach  and   Liver,  by  Age,  Males,  United 

States  Registration  Area,  1903-1907  Compared  with  1908-1912 445 

66  Mortality  from  Cancer  of  the  Stomach  and  Liver,  by  Age,  Females,  United 

States  Registration  Area,  1903-1907  Compared  with  1908-1912 445 

67  Mortality  from  Cancer  of  the  Peritoneum,  Intestines  and  Rectum,  by  Age, 

Males,  United  States  Registration  Area,  1903-1907  Compared  with  1908-1912    446 

68  Mortality  from  Cancer  of  the  Peritoneum,  Intestines  and  Rectum,  by  Age,  Fe- 

males, United  States  Registration  Area,  1903-1907  Compared  with  1908-1912     44C 

420 


APPENDIX  F  (PART  I) 

Table  Page 

(59     Mortality  from  Cancer  of  the  Female  Generative  Organs,  by  Age,  United  States 

Registration  Area,  1903-1907  Compared  with  1908-1912 447 

70  Mortality  from  Cancer  of  the  Female  Breast,  by  Age,  United  States  Registra- 

tion Area,  1903-1907  Compared  with  1908-1912 447 

71  Mortality  from  Cancer  of  the  Skin,  by  Age,  Males,  United  States  Registration 

Area,  1903-1907  Compared  with  1908-1912 448 

72  Mortality  from  Cancer  of  the  Skin,  by  Age,  Females,  United  States  Registration 

Area,  1903-1907  Compared  with  1908-1912 448 

73  Mortality  from  Cancer  of  Other  or  Not  Specified  Organs  and  Parts,  by  Age, 

Males,  United  States  Registration  Area,  1903-1907  Compared  with  1908-1912    449 

74  Mortality  from  Cancer  of  Other  or  Not  Specified  Organs  and  Parts,  by  Age, 

Females,  United  States  Registration  Area,  1903-1907  Compared  with  1908- 
1912 449 


421 


APPENDIX  F  (PART  I) 


Table  1 

Table  2 

Estimated   Mortality   from    Cancer 

Mortality  from  Cancer 

Continental  United  States 

United  States  Registration  Area 

1900 

■1913 

1900-1913 

Population 

Cancer  Death 

Estimated 

Deaths 

Rate  per 

Year 

Continental 

(.ate  per  1  OOjOOO 
U.  S.  Regis- 

No. of  Deaths 

Year 

Population 

from 

100,000 

United  States 

tration  Area 

from  Cancer 

Cancer 

Population 

1900 

75,994,575 

62.9 

47,829 

1900 

30,794,273 

19,381 

62.9 

1901 

77,592,344 

64.3 

49,890 

1901 

31,370,952 

20,171 

64.3 

1902 

79,190,113 

65.1 

51,542 

1902 

32,029,815 

20,847 

65.1 

1903 

80,787,882 

68.3 

55,153 

1903 

32,701,083 

22,325 

68.3 

1904 

82,385,651 

70.2 

57,794 

1904 

33,349,137 

23,395 

70.2 

1905 

83,983,420 

71.4 

59,931 

1905 

34,094,605 

24,330 

71.4 

1906 

85,581,189 

69.1 

59,155 

1906 

41,983,419 

29,020 

69.1 

1907 

87,178,958 

70.9 

61,840 

1907 

43,016,990 

30,514 

70.9 

1908 

88,776,727 

71.5 

63,494 

1908 

46,789,913 

33,465 

71.5 

1909 

90,374,496 

73.8 

66,731 

1909 

50,870,518 

37,562 

73.8 

1910 

91,972,266 

76.2 

70,099 

1910 

53,843,896 

41,039 

76.2 

1911 

93,570,036 

74.3 

69,494 

1911 

59,275,977 

44,024 

74.3 

1912 

95,167,806 

77.0 

73,282 

1912 

60,427,247 

46,531 

77.0 

1913 

96,765,576 

78.9 

76,319 

1913 

63,298,718 

49,928 

78.9 

Table  3 

Table  4 

Mortality  from  Cancer 

Mortality  from  Cancer 

United  States  Registration  States* 

United 

States  Reg 

istration  Cities 

1900 

-1913 

Rate  per 

1900-1 

J13 

Deaths 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1900 

19,965,149 

12,769 

63.5 

1900 

21,504,735 

13,672 

63.6 

1901 

20,307,043 

13,438 

66.2 

1901 

22,252,010 

14,450 

64.9 

1902 

20.648,941 

13,653 

66.1 

1902 

22,858,803 

15,038 

65.8 

1903 

20,990,841 

14,650 

69.8 

1903 

23,465,153 

16,173 

68.9 

1904 

21,336,715 

15,247 

71.5 

1904 

21,041,724 

17,040 

70.9 

1905 

21,736,908 

15,983 

73.5 

1905 

24,729,925 

17,670 

71.5 

1906 

33,836,029 

23,399 

69.2 

1906 

26,342,431 

19,492 

74.0 

1907 

34,608,896 

24,666 

71.3 

1907 

27,145,619 

20,384 

75.1 

1908 

38.705,861 

27,617 

71.4 

1908 

28,501,322 

21,602 

75.8 

1909 

44,281,685 

32,723 

73.9 

1909 

29,655,238 

23,325 

78.7 

1910 

47,807,766 

36,364 

76.1 

1910 

31,223,935 

25,180 

80.6 

1911 

54,385,234 

40,229 

74.0 

1911 

32,376i200 

26,310 

81.3 

1912 

55,252,123 

42,464 

76.9 

1912 

33,304,948 

27,949 

83.9 

1913 

58,312,595 

45,833 

78.6 

1913 

34,230,283 

29,767 

87.0 

'Includes  District  of  Columbia 

Table  5 

Table 

6 

Mortality  from  Cancer,  California 

Mortality  from  Cancer,  Colorado 

1906- 

1913 

Rate  per 

1906-1913 

Deaths 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1906 

2,034,859 

1,517 

74.6 

1906 

699,451 

316 

45.2 

1907 

2,125,238 

1,606 

75.6 

1907 

725,712 

346 

47.7 

1908 

2,215,618 

1,774 

80.1 

1908 

751,973 

402 

53.5 

1909 

2,305,998 

1,983 

86.0 

1909 

778,234 

419 

53.8 

1910 

2,396,378 

2,013 

84.0 

1910 

804,495 

468 

58.2 

1911 

2,480,757 

2,053 

82.6 

1911 

830,755 

459 

55.3 

1912 

2,577,137 

2,338 

90.7 

1912 

857,016 

497 

58.0 

1913 

2,067,516 

2,003 

97.6 

1913 

883,276 

448 

50.7 

422 


APPENDIX  F  {PART  I) 


Table  7 

Mortality  from  Cancer,  Connecticut 

1900-1913 


Year 

1900 
1901 
1902 

1903 
1904 
1905 
1906 
1907 
1908 
1909 
1910 
1911 
1912 
1913 


Population 

910,161 

931,055 

951,949 

972,844 

993,739 

1,014,634 

1,035,529 

1,056,424 

1,077,319 

1,098,214 

1,119,109 

1,140,003 

1,160,898 

1,181,793 


Deaths 

from 
Cancer 

624 
650 
643 
731 
670 
751 
811 
819 
790 
882 
893 
895 
945 
1,006 


Rate  per 

100,000 

Population 

68.6 
69.8 
67.5 
75.1 
67.4 
74.0 
78.3 
77.5 
73.3 
80.3 
79.8 
78.5 
81.4 
85.1 


Table  9 

Mortality  from  Cancer,  Kentucky 

1911-1913 


Table  8 

Mortality  from  Cancer,  Indiana 

1900-1913 


Year 

1900 
1901 
1902 
1903 
1904 
1905 
1906 
1907 
1908 
1909 
1910 
1911 
1912 
1913 


Population 

2,518,018 
2,536,692 
2,555,307 
2,574,042 
2,592,717 
2,611,392 
2,630,067 
2,648,742 
2,667,417 
2,686,092 
2,704,767 
2,723,441 
2,742,117 
2,760,792 


Deaths 

from 
Cancer 

1,077 
1,125 
1,237 
1,289 
1,334 
1,482 
1,456 
1,567 
1,795 
1,856 
1,898 
1,943 
2,030 
2,239 


Rate  per 
100,000 
Population 
42.8 
44.3 
48.4 
50.1 
51.5 
56.8 
55.4 
59.2 
67.3 
69.1 
70.2 
71.3 
74.0 
81.1 


Table  10 

Mortality  from  Cancer,  Maine 

1900-1913 


Year 

1911 
1912 
1913 


Population 

2,307,369 
2,321,823 
2,336,277 


Deaths 

from 

Cancer 

986 

1,043 

1,122 


Rate  per 

100,000 

Population 

42.7 
44.9 
48.0 


Year 

1906 
1907 
1908 
1909 
1910 
1911 
1912 
1913 


Table  11 

Mortality  from  Cancer 

Maryland,   1906-1913 

Deaths       Rate  per 


Population 

1,254,146 
1,265,012 
1,275,878 
1,286,744 
1,297,610 
1,308,476 
1.319,343 
1,330,209 


from 
Cancer 

767 
785 
821 
800 
942 
955 
1,042 
1.102 


100,000 
Population 
61.2 
62.1 
64.3 
62.2 
72.6 
73.0 
79.0 
82.8 


Deaths 

Year 

Population 

from 
Cancer 

1900 

694,870 

518 

1901 

699,721 

575 

1902 

704,572 

608 

1903 

709,423 

599 

1904 

714,274 

611 

1905 

719,125 

661 

1906 

723,976 

616 

1907 

728,827 

727 

1908 

733,678 

695 

1909 

738,530 

727 

1910 

743,382 

754 

1911 

748,233 

738 

1912 

753,085 

829 

1913 

757,936 

815 

Rate  per 

100,000 

Population 

74.5 

82.2 

86.3 

84.4 

85.5 

91.9 

85.1 

99.7 

94.7 

98.4 

101.4 

98.6 

110.1 

107.5 


Year 

1900 
1901 
1902 
1903 
1904 
1905 
1906 
1907 
1908 
1909 
1910 
1911 
1912 
1913 


Table  12 

Mortality  from  Cancer 

Massachusetts,  1900-1913 

Deaths 


Population 

2,805,346 
2,845,012 
2,884,679 
2,924,346 
2,964,013 
3,015,?73 
3,089,029 
3,162,186 
3,235,343 
3,308,500 
3,381,657 
3,454,813 
3,491,888 
3,548,705 


from 
Cancer 

2,092 
2,183 
2,233 
2,367 
2,607 
2,682 
2,748 
2,883 
2,927 
2,972 
3,159 
3,262 
3,407 
3,597 


Rate  per 
100,000 
Population 
74.6 
76.7 
77.4 
80.9 
88.0 
88.9 
89.0 
91.2 
90.5 
89.8 
93.4 
94.4 
97.6 
101.4 


APPENDIX  F  {PART  I) 


Table 

13 

Table 

14 

Mortality  from  Cancer,  Michigan 

Mortality  from  Cancer,  Minnesota 

1900-1913 

Rate  per 

1910-1913 

Deaths 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

PopulatioE 

1900 

2,420,982 

1,482 

61.2 

1910 

2,079,801 

1,400 

67.3 

1901 

2,448,240 

1,468 

60.0 

1911 

2,099,451 

1,423 

67.8 

1902 

2,475,498 

1,476 

59.6 

1912 

2,148,235 

1,498 

69.7 

1903 

2,502,757 

1,689 

67.5 

1913 

2,181,077 

1,638 

75.1 

1904 

2,533,990 

1,706 

67.3 

1905 

2,581.676 

1,643 

63.6 

1906 

2,629,362 

1,748 

66.5 

1907 

2,677,048 

1,741 

65.0 

1908 

2,724,734 

1,924 

70.6 

1909 

2,772,421 

1,953 

70.4 

1910 

2,820,108 

2,112 

74.9 

1911 

2,867,794 

2,137 

74.5 

1912 

2,897,207 

2,276 

78.6 

1913 

2,936,618 

2,392 

81.5 

Table  15 

Table  16 

Mortality  from  Cancer,  Missouri 

Mortality  from  Cancer,  Montana 

1911- 

■1913 

Rate  per 

1910-1913 

Deaths 

Deaths      Rate  per 

Year 

Population 

from 
Cancer 

100,000 
Population 

Year 

Population 

from          100,000 
Cancer    Populatioi 

1911 

3,321,094 

1,974 

59.4 

1910 

378,853 

157         41.4 

1912 

3,335,080 

2,142 

64.2 

1911 

392,293 

157         40.0 

1913 

3,353,983 

2,250 

67.1 

1912 
1913 

405,734 
419,174 

164          40.4 
207         49.4 

Table  17 

Mortality  from  Cancer 

New  Hampshire 

1900-1913 


Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Cancer 

Population 

1900 

411,748 

296 

71.9 

1901 

413,670 

364 

88.0 

1902 

415,592 

340 

81.8 

1903 

417,514 

327 

78.3 

1904 

419,436 

342 

81.5 

1905 

421,358 

359 

85.2 

1906 

423,280 

386 

91.2 

1907 

425,203 

418 

98.3 

1908 

427,126 

384 

89.9 

1909 

429,049 

401 

93.5 

1910 

430,972 

424 

98.4 

1911 

432,894 

419 

96.8 

1912 

434,818 

467 

107.4 

1913 

436,740 

456 

104.4 

424f 


APPENDIX  F  {PART  I) 


Table  18 

Table 

19 

Mortality  from  Cancer 

Mortality  from  Cancer 

New  J 

ersey 

New  York 

1900- 

1913 

Rate  per 

1900-1913 

Deaths 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1900 

1,883,669 

1,016 

53.9 

1900 

7,268,894 

4,847 

66.7 

1901 

1,935,763 

1,126 

58.2 

1901 

7,428,576 

5,186 

69.8 

190^ 

1,987,858 

1,064 

53.5 

1902 

7,588,259 

5,227 

68.9 

1903 

2,039,953 

1,189 

58.3 

1903 

7,747,942 

5,558 

71.7 

1904 

2,092,048 

1,205 

57.6 

1904 

7,907,625 

5,834 

73.8 

1905 

2,150,861 

1,356 

63.0 

1905 

8,085,194 

6,139 

75.9 

1906 

2,231,481 

1,451 

65.0 

1906 

8,299,820 

6,273 

75.6 

1907 

2,312,101 

1,470 

63.6 

1907 

8,514,447 

6,614 

77.7 

1908 

2,392,721 

1,553 

64.9 

1908 

8,729,074 

6,797 

77.9 

1909 

2,473,342 

1,681 

68.0 

1909 

8,943,701 

7,262 

81.2 

1910 

2,553,963 

1,891 

74.0 

1910 

9,158,328 

7,726 

84.4 

1911 

2,634,583 

1,966 

74.6 

1911 

9,372,954 

8,091 

86.3 

1912 

2,683,309 

2,054 

76.5 

1912 

9,526,146 

8,209 

86.2 

1913 

2,749,486 

2,156 

78.4 

1913 

9,712,954 

8,531 

87.8 

Table  20 

Table 

21 

Mortality  from  Cancer,  N.  Carolina  * 

Mortality  from 

Cancer, 

Ohio 

1910- 

1913 

Rate  per 

1909-1913 

Deaths 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1910 

361,941 

171 

47.2 

1909 

4,718,251 

3,470 

73.5 

1911 

374,314 

205 

54.8 

1910 

4,779,981 

3,599 

75.3 

1912 

385,790 

219 

56.8 

1911 

4,841,710 

3,699 

76.4 

1913 

396,927 

190 

47.9 

1912 

4,903,439 

3,936 

80.3 

•  Includes 

only  municipalities  having 

a  population 

1913 

4,965,169 

4,061 

81.8 

of  1,000  or  over  in  1900. 

Table  22 

Mortality  from  Cancer,Pennsylvania 

1906-1913 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Cancer 

Population 

1906 

7.141,766 

4,208 

58.9 

1907 

7,279,791 

4,420 

60  7 

1908 

7,417,816 

4,520 

60  9 

1909 

7,555,841 

4,845 

64  1 

1910 

7,693,866 

5,100 

66.3 

1911 

7,831,890 

5,197 

66.4 

1912 

7,969,916 

5,426 

68.1 

1913 

8,107,942 

5,854 

72.2 

425 


APPENDIX  F  {PART  I) 


Table  23 

Table  24 

Mortality  from  Cancer 

Mortality  from  Cancer 

Rhode 

Island 

South  Dakota 

1900 

-1913 

Rate  per 

1906-1909 

Deaths 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1900 

428,556 

302 

70.5 

1906 

487,094 

165 

33.9 

1901 

438,861 

319 

72.7 

1907 

512,622 

185 

36.1 

1902 

449,166 

370 

82.4 

1908 

538,150 

225 

41.8 

1903 

459,471 

355 

77.3 

1909 

563,678 

172 

30.5 

1904 

4.69,776 

407 

86.6 

1905 

481,150 

386 

80.2 

1906 

493,976 

384 

77.7 

1907 

506,802 

456 

90.0 

1908 

519,628 

427 

82.2 

1909 

532,455 

466 

87.5 

1910 

545,282 

474 

86.9 

1911 

558,108 

491 

88.0 

1912 

568,114 

510 

89.8 

1913 

579,665 

541 

93.3 

Table  25 

Table 

26 

Mortality  from  Cancer, 

Utah 

Mortality  from  Cancer,  Vermont 

1910- 

1913 

Rate  per 

1900-1913 

Deaths 

Deaths 

Rate  per 

Year 

Population 

from 

100.000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1910 

375,389 

134 

35.7 

1900 

343,745 

302 

87.9 

1911 

385,171 

200 

51.9 

1901 

344,992 

243 

70.4 

1912 

394,953 

188 

47.6 

1902 

346,239 

239 

69.0 

1913 

404,735 

211 

52.1 

1903 

347,486 

325 

93.5 

1904 

348,733 

303 

86.9 

1905 

349,980 

294 

84.0 

1906 

351,227 

299 

85.1 

1907 

352,474 

348 

98.7 

1908 

353,721 

325 

91.9 

1909 

354,968 

345 

97.2 

1910 

356,216 

393 

110.3 

1911 

357,463 

361 

101.0 

1912 

358,710 

396 

110.4 

1913 

359,957 

402 

111.7 

Table  27 

Table  28 

Mortality  from  Cancer,  Washington 

Mortality  from  Cancer,  Wisconsin 

1908- 

1913 

Rate  per 

1908-1913 

Deaths 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1908 

1,028,794 

466 

45.3 

1908 

2,295,302 

1,513 

65.9 

1909 

1,091,973 

559 

51.2 

1909 

2,310,822 

1,645 

71.0 

1910 

1,155,152 

593 

51.3 

1910 

2,338,343 

1,763 

75.4 

1911 

1,218,330 

562 

46.1 

1911 

2,359,863 

1,763 

74.7 

1912 

1,281,508 

679 

53.0 

1912 

2,393,081 

1,841 

76.9 

1913 

1,344,086 

720 

53.5 

1913 

2,419,898 

1.899 

78.5 

426 


APPENDIX  F  {PART  1) 


Table  29 
Estimated    Mortality    from    Malig- 
nant and  Benign  Tumors  in 
Continental  United  States 
1900-1913 


Table  30 

Estimated    Mortality    from    Benign 

Tumors  in  Continental 

United  States 

1900-1913 


Death  Rate 

Estimated 

Death  Rate 

Population 

per  100,000 

Deaths  from 
iralignant 
and  Benign 

Population 

per  100,000 

Estimated 
Deaths  from 

Year 

Continental 

Population 

Year 

Continental 

Population 

Benign 

United  States  U.S.Reg.  Area 

Tumors 

United  States  U.S. Reg.  Area 

Tumors 

1900 

75,994,575 

67.3 

51,173 

1900 

75,994,575 

4.4 

3,344 

1901 

77,592,344 

68.9 

5.3,459 

1901 

77,592,344 

4.6 

3,569 

1902 

79,190,113 

69.6 

55,106 

1902 

79,190,113 

4.5 

3,564 

1903 

80,787,882 

73.2 

59,112 

1903 

80,787,882 

4.9 

3,959 

1904 

82,385,651 

74.7 

61,501 

1904 

82,385,651 

4.5 

3,707 

1905 

83,983,420 

76.0 

63,794 

1905 

83,983,420 

4.6 

3,863 

1906 

85,581,189 

73.0 

62,493 

1906 

85,581,189 

3.9 

3,338 

1907 

87,178,958 

75.1 

65,502 

1907 

87,178,958 

4.2 

3,662 

1908 

88,776,727 

75.3 

66,868 

1908 

88,776,727 

3.8 

3,374 

1909 

90,374,496 

77.5 

70,075 

1909 

90,374,496 

3.7 

3,344 

1910 

91,972,266 

79.9 

73,502 

1910 

91,972,266 

3.7 

3,403 

1911 

93,570,036 

77.7 

72,675 

1911 

93,570,036 

3.4 

3,181 

1912 

95,167,806 

80.3 

76,423 

1912 

95,167,806 

3.3 

3,141 

1913 

96,765,576 

82.2 

79,567 

1913 

96,765,576 

3.4 

3,248 

Table 

31 

Table  32 

Mortality  from  Cancer,  United 

Mortality  from 

Cancer,  United 

States  Registration  Area 

States  Registration  Area 

Males 

Females 

1900-1913 

Rate  per 

1900-] 

1913 

Deaths 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1900 

15,415,757 

7,294 

47.3 

1900 

15,378,516 

12,087 

78.6 

1901 

15,742,434 

7,706 

49.0 

1901 

15,628,518 

12,465 

79.8 

1902 

16,111,848 

7,798 

48.4 

1902 

15,917,967 

13,049 

82.0 

1903 

16,489,113 

8,422 

51.1 

1903 

16,211,970 

13,903 

85.8 

1904 

16,856,270 

8,881 

52.7 

1904 

16,492,867 

14,514 

88.0 

1905 

17,274,352 

9,189 

53.2 

1905 

16,820,253 

15,141 

90.0 

1906 

21,322,133 

11,166 

52.4 

1906 

20,661,286 

17,854 

86.4 

1907 

21,899,144 

11,800 

53.9 

1907 

21,117,846 

18,714 

88.6 

1908 

23,876,529 

13,046 

54.6 

1908 

22,913,384 

20,410 

89.1 

1909 

26,020,431 

14,918 

57.3 

1909 

24,850,087 

22,644 

91.1 

1910 

27,606,526 

16,373 

59.3 

1910 

26,237,370 

24,666 

94.0 

1911 

30,463,411 

17,525 

57.5 

1911 

28,812,566 

26,499 

92.0 

1912 

31,128,193 

18,464 

59.3 

1912 

29,298,940 

28,067 

95.8 

1913 

32,681,358 

20,045 

61.3 

1913 

30,617,806 

29,883 

97.6 

427 


APPENDIX  F  (PART  I) 

Table  33 

Mortality  from  Benign  Tumors 

United  States  Registration  Area 

1900-1913 


Ali. 

Htdatid 

Tumor 

Tumor 

Tumor  of 

Specified  Fobus 

Tumor  of  Liveb 

OF  Uterus 

OF  Ovaries 

Other  Obqans 

Rate  per 

Rate  per 

Rate  per 

Rate  per 

Rate  per 

Year 

Deaths 

100,000 

Deaths    100,000 

Deaths 

100,000 

Deaths 

100,000 

Deaths    100,000 

?opulatioii 

Population 

Population 

Population 

Population 

1900 

1,343 

4.4 

10       0.03 

403 

1.3 

349 

1.1 

581         1.9 

1901 

1,453 

4.6 

8       0.03 

529 

1.7 

411 

1.3 

505         1.6 

1902 

1,437 

4.5 

14       0.04 

536 

1.7 

428 

1.3 

459         1.4 

1903 

1,587 

4.9 

9       0.03 

608 

1.9 

439 

1.3 

531         1.6 

1904 

1,509 

4.5 

12      0.04 

620 

1.9 

433 

1.3 

444         1.3 

1905 

1,566 

4.6 

14       0.04 

611 

1.8 

440 

1.3 

501         1.5 

1906 

1,645 

3.9 

13      0.03 

731 

1.7 

431 

1.0 

470         1.1 

1907 

1,786 

4.2 

9      0.02 

813 

1.9 

456 

1.1 

508         1.2 

1908 

1,770 

3.8 

13      0.03 

845 

1.8 

454 

1.0 

458         1.0 

1909 

1,857 

3.7 

19      0.04 

862 

1.7 

518 

1.0 

458        0.9 

1910 

2,010 

3.7 

24      0.04 

933 

1.7 

500 

0.9 

553         1.0 

1911 

1,999 

3.4 

24       0.04 

892 

1.5 

628 

1.1 

455         0.8 

1912 

2,001 

3.3 

25       0.04 

1,053 

1.7 

546 

0.9 

377         0.6 

1913 

2,125 

3.4 

15       0.02 

1,173 

1.9 

640 

1.0 

297        0.5 

Table  34 

Mortality  from  Benign  Tumors,  Males 

United  States  Registration  Area 

1900-1913 


All  Specified  Forms 

Hydatid  Tumor  of  Liver 

TuMOB  OF  Other  Organs 

Rate  per 

Rate  per 

Rate  per 

Year 

Deaths 

100,000 
Population 

Deaths 

100,000 
Population 

Deaths 

100,000 
Population 

1900 

165 

1.1 

8 

0.05 

157 

1.0 

1901 

154 

1.0 

3 

0.02 

151 

1.0 

1902 

129 

0.8 

6 

0.04 

123 

0.8 

1903 

158 

1.0 

6 

0.04 

152 

0.9 

1904 

120 

0.7 

7 

0.04 

113 

0.7 

1905 

148 

0.9 

11 

0.06 

137 

0.8 

1906 

124 

0.6 

9 

0.04 

115 

0.5 

1907 

146 

0.7 

6 

0.03 

140 

0.6 

1908 

122 

0.5 

5 

0.02 

117 

0.5 

1909 

136 

0.5 

8 

0.03 

128 

0.5 

1910 

162 

0.6 

20 

0.07 

142 

0.5 

1911 

127 

0.4 

11 

0.04 

116 

0.4 

1912 

109 

0.4 

13 

0.04 

96 

0.3 

1913 

97 

0.3 

9 

0.03 

88 

0.3 

428 


APPENDIX  F  (PART  I) 

Table  35 

Mortality  from  Benign  Tumors,  Females 

United  States  Registration  Area 

1900-1913 


All 
Specified  Forms 

Hydatid 

Tumor  of  Liver 

Tumor 
of  Uterus 

Tumor 
OF  Ovaries 

Tumor  of 
Other  Organs 

Year 

Deaths 

Rate  per 

100,000 

Population 

Rate  per 
Deaths    100,000 
Population 

Deaths 

Rate  per 

100,000 

Population 

Deaths 

Rate  per 

100,000 

Population 

Deaths 

Rate  per 

100,000 

Population 

1900 

1,178 

7.7 

2        0.01 

403 

2.6 

349 

2.3 

424 

2.8 

1901 

1,299 

8.3 

5       0.03 

529 

3.4 

411 

2.6 

354 

2.3 

1902 

1,308 

8.2 

8       0.05 

536 

3.4 

428 

2.7 

336 

2.1 

1903 

1,429 

8.8 

3      0.02 

608 

3.8 

439 

2.7 

379 

2.3 

1904 

1,389 

8.4 

5       0.03 

620 

3.8 

433 

2.6 

331 

2.0 

1905 

1,418 

8.4 

3      0.02 

611 

3.6 

440 

2.6 

364 

2.2 

1906 

1,521 

7.4 

4      0.02 

731 

3.5 

431 

2.1 

355 

1.7 

1907 

1,640 

7.8 

3      0.01 

813 

3.8 

456 

2.2 

368 

1.7 

1908 

1,648 

7.2 

8      0.03 

845 

3.7 

454 

2.0 

341 

1.5 

re09 

1,721 

6.9 

11       0.04 

862 

3.5 

518 

2.1 

330 

1.3 

1910 

1,848 

7.0 

4      0.02 

933 

3.6 

500 

1.9 

411 

1.6 

1911 

1,872 

6.5 

13      0.05 

892 

3.1 

628 

2.2 

339 

1.2 

1912 

1,892 

6.5 

12      0.04 

1,053 

3.6 

546 

1.9 

281 

1.0 

1913 

2,028 

6.6 

6      0.02 

1,173 

3.8 

640 

2.1 

209 

0.7 

Table  36 

Mortality  from  Ulcer  of  the  Stomach,  by  Sex 

United  States  Registration  Area 

1900-1913 


Total 

Males 

Females 

Year 

Deaths 

Rate  per 

100,000 

Population 

Deaths 

Rate  per 

100,000 

Population 

Deaths 

Rate  per 

100,000 

Population 

1900 

804 

2.6 

419 

2.7 

385 

2.5 

1901 

871 

2.8 

439 

2.8 

432 

2.8 

1902 

905 

2.8 

465 

2.9 

440 

2.8 

1903 

905 

2.8 

465 

2.8 

440 

2.7 

1904 

1,044 

3.1 

524 

3.1 

520 

3.2 

1905 

1,094 

3.2 

615 

3.6 

479 

2.8 

1906 

1,423 

3.4 

731 

3.4 

692 

3.3 

1907 

1,481 

3.4 

802 

3.7 

679 

3.2 

1908 

1,523 

3.3 

866 

3.6 

657 

2.9 

1909 

1,770 

3.5 

1,009 

3.9 

761 

3.1 

1910 

2,203 

4.1 

1,273 

4.6 

930 

3.5 

1911 

2,143 

3.6 

1,222 

4.0 

921 

3.2 

1912 

2,316 

3.8 

1,398 

4.5 

918 

3.1 

1913 

2,536 

4.0 

1,483 

4.5 

1,053 

3.4 

429 


APPENDIX  F  (PART  I) 

Table  37 

Mortality  from  Biliary  Calculi,  by  Sex 

United  States  Registration  Area 

1900-1913 


To  PAL 

Males 

Females 

Year 

Deaths 

Rate  per 

100,000 

Population 

Deaths 

Rate  per 

100,000 

Population 

Deaths 

Rate  per 

100,000 

Population 

1900 

459 

1.5 

149 

1.0 

310 

2.0 

1901 

500 

1.6 

145 

0.9 

355 

2.3 

1902 

668 

2.1 

219 

1.4 

449 

2.8 

1903 

795 

2.4 

235 

1.4 

560 

3.5 

1904 

832 

2.5 

264 

1.6 

568 

3.4 

1905 

883 

2.6 

263 

1.5 

620 

3.7 

1906 

1,134 

2.7 

338 

1.6 

796 

3.9 

1907 

1,110 

2.6 

343 

1.6 

767 

3.6 

1908 

1,275 

2.7 

377 

1.6 

898 

3.9 

1909 

1,486 

2.9 

447 

1.7 

1,039 

4.2 

1910 

1,501 

2.8 

461 

1.7 

1,040 

4.0' 

1911 

1,749 

3.0 

510 

1.7 

1,239 

4.3 

1912 

1,793 

3.0 

529 

1.7 

1,264 

4.3 

1913 

1,999 

3.2 

595 

1.8 

1,404 

4.6 

Table  38 

Mortality  from  Calculi  of  the  Urinary  Tract,  by  Sex 

United  States  Registration  Area 

1900-1913 


Total 

Males 

Females 

Year 

Deaths 

Rate  per 

100,000 

Population 

Deaths 

Rate  per 

100,000 

Population 

Deaths 

Rate  per 

100,000 

Population 

1900 

116 

0.4 

82 

0.5 

34 

0.2 

1901 

126 

0.4 

95 

0.6 

31 

0.2 

1902 

150 

0.5 

118 

0.7 

32 

0.2 

1903 

151 

0.5 

113 

0.7 

38 

0.2 

1904 

154 

0.5 

121 

0.7 

33 

0.2 

1905 

193 

0.6 

141 

0.8 

52 

0.3 

1906 

227 

0.5 

170 

0.8 

57 

0.3 

1907 

229 

0.5 

163 

0.7 

66 

0.3 

1908 

250 

0.5 

175 

0.7 

75 

0.3 

1909 

292 

0.6 

218 

0.8 

74 

0.3 

1910 

329 

0.6 

241 

0.9 

88 

0.3 

1911 

361 

0.6 

260 

0.9 

101 

0.4 

1912 

358 

0.6 

247 

0.8 

111 

0.4 

1913 

403 

0.6 

291 

0.9 

112 

0.4 

430 


APPENDIX  F  {PART  1) 

Table  39 
Comparative  Mortality  from  Cancer,  by  Race,  United  States  Registration 

Area,  1910-1912 

WHITE 
Year  Population 

1910. 51,690,975 

1911 56,763,765 

1912 57,874,275 


Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

39,875 

77.1 

42,593 

75.0 

45,076 

77.9 

1910-1912 166,329,015  127,544  76.7 

COLORED 

1910 2,152,921  1,164  54.1 

1911 2,512,212  1,431  57.0 

1912 2,552,858  1,455  57.0 


1910-1912 7,217,991  4,050  56.1 

Table  40 
Comparative  Urban  and  Rural  Mortality  from  Cancer,  United  States  Regis- 
tration States,  1900-1913 

URBAN 
Year  Population 

1900 10,675,611 

1901 11,188,101 

1902 11,477,929 

1903 11,754,911 

1904 12,029,302 

1905 12,372,228 

1906 18,195,041 

1907 18,737,525 

1908 20,417,270 

1909 23,066,405 

1910 25,187,805 

1911 27,485,457 

1912 28,129,824 

1913 29,244,160                25,672                87.8 

RURAL 

1900 9,289,538 

1901 9,118,942 

1902 9,171,012 

1903 9,235,930 

1904 9,307,413 

1905 9,364,680 

1906 15,640,988 

1907 15,871,371 

1908 18,288,591 

1909 21,215,280 

1910 22,619,961 

1911 26,899,777 

1912 27,122,299 

1913 29,068,435 

431 


Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

7,060 

66.1 

7,717 

69.0 

7,844 

68.3 

8,498 

72.3 

8,892 

73.9 

9,323 

75.4 

13,871 

76.2 

14,536 

77.6 

15,754 

77.2 

18,486 

80.1 

20,505 

81.4 

22,515 

81.9 

23,882 

84.9 

5,709 

61.5 

5,721 

62.7 

5,809 

63.3 

6,152 

66.6 

6,355 

68.3 

6,660 

71.1 

9,528 

60.9 

10,130 

63.8 

11,863 

64.9 

14,237 

67.1 

15,859 

70.1 

17,714 

65.9 

18,582 

68.5 

20,161 

69.4 

APPENDIX  F  {PART  I) 

Table  41 

Mortality  from  Cancer  of  the  Buccal  Cavity,  by  Sex 

United  States  Registration  Area 

1900-1913 


Total 

Males 

Females 

Deaths 

Rate  per 

Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

from 

100,000 

from 

100,000 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

Cancer 

Population 

1900 

495 

1.6 

377 

2.4 

118 

0.8 

1901 

612 

2.0 

496 

3.2 

116 

0.7- 

1902 

583 

1.8 

461 

2.9 

122 

0.8 

1903 

661 

2.0 

527 

3.2 

134 

0.8 

1904 

737 

2.2 

591 

3.5 

146 

0.9 

1905 

792 

2.3 

643 

3.7 

149 

0.9 

1906 

941 

2.2 

762 

3.6 

179 

0.9 

1907 

968 

2.3 

788 

3.6 

180 

0.9 

1908 

1,148 

2.5 

950 

4.0 

198 

0.9 

1909 

1,427 

2.8 

1,195 

4.6 

232 

0.9 

1910 

1,576 

2.9 

1,329 

4.8 

247 

0.9 

1911 

1,727 

2.9 

1,402 

4.6 

325 

1.1 

1912 

1,838 

3.0 

1,465 

4.7 

373 

1.3 

1913 

1.966 

3.1 

1,628 

5.0 

338 

1.1 

Table  42 

Mortality  from  Cancer  of  the  Stomach  and  Liver,  by  Sex 

United  States  Registration  Area 

1900-1913 


Total 

Males 

Females 

Deaths 

Rate  per 

Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

from 

100,000 

from 

100,000 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

Cancer 

Population 

1900 

6,918 

22.5 

3,418 

22.2 

3,500 

22.8 

1901 

7,095 

22.6 

3,594 

22.8 

3,501 

22.4 

1902 

7.483 

23.4 

3,681 

22.8 

3,802 

23.9 

1903 

8,193 

25.1 

4,037 

24.5 

4,156 

25.6 

1904 

8,744 

26.2 

4,340 

25.7 

4,404 

26.7 

1905 

8,939 

26.2 

4,388 

25.4 

4,551 

27.1 

1906 

10,946 

26.1 

5,443 

25.5 

5,503 

26.6 

1907 

11,596 

27.0 

5,779 

26.4 

5,817 

27.5 

1908 

13,044 

27.9 

6,537 

27.4 

6,507 

28.4 

1909 

14,915 

29.3 

7,477 

28.7 

7,438 

29.9 

1910 

16,475 

30.6 

8,135 

29.5 

8,340 

31.8 

1911 

17,365 

29.3 

8,698 

28.6 

8,667 

30.1 

1912 

18,517 

30.6 

9,215 

29.6 

9,302 

31.7 

1913 

19,767 

31.2 

9,749 

29.8 

10,018 

32.7 

432 


APPENDIX  F  {PART  I) 

Table  43 

Mortality  from  Cancer  of  the  Peritoneum,  Intestines  and  Rectum,  by  Sex 

United  States  Registration  Area 

1900-1913 


ToTAi 

Males 

Fem-u, 

E3 

Deaths 

Rate  per 

Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

from 

100,000 

from 

100,000- 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

Cancer 

Population 

1900 

1,7G0 

5.7 

792 

5.1 

968 

6.3 

1901 

2.157 

6.9 

935 

5.9 

1,222 

7.8 

1902 

2.239 

7.0 

1,014 

6.3 

1,225 

7.7 

1903 

2,134 

6.5 

899 

5.5 

1,235 

7.6 

1904 

2,399 

7.2 

1,054 

6.3 

1,345 

8.2 

1905 

2,732 

8.0 

1,129 

6.5 

1,603 

9.5 

1906 

3,273 

7.8 

1,320 

6.2 

1,953 

9.5 

1907 

3,570 

8.3 

1,497 

6.8 

2,073 

9.8 

1908 

3,963 

8.5 

1,649 

6.9 

2,314 

10.1 

1909 

4,676 

9.2 

1,961 

7.5 

2,715 

10.9 

1910 

5,258 

9.8 

2,183 

7.9 

3,075 

11.7 

1911 

5,824 

9.8 

2,464 

8.1 

3,360 

11.7 

1912 

5,923 

9.8 

2,459 

7.9 

3,464 

11.8 

1913 

6,625 

10.5 

2,811 

8.6 

3,814 

12.5 

Table  44 

Mortality  from  Cancer  of  the  Female  Generative  Organs  and  Female  Breast 

United  States  Registration  Area 

1900-1913 


Female  Generative  Organs 

Female  Breast 

Year 

Deaths 

from 

Cancer 

Rate  per 

100,000 

Total 

Population 

Rate  per 

100,000 

Female 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Total 

Population 

Rate  per 

100,000 

Female 

Population 

1900 

2,696 

8.8 

17.5 

1,400 

4.5 

9.1 

1901 

2,919 

9.3 

18.7 

1,621 

5.2 

10.4 

1902 

3,033 

9.5 

19.1 

1,734 

5.4 

10.9 

1903 

3,289 

10.1 

20.3 

1,777 

5.4 

11.0 

1904 

3,436 

10.3 

20.8 

2,019 

6.1 

12.2 

1905 

3,637 

10.7 

21.6 

1,994 

5.8 

11.9 

1906 

4,090 

9.7 

19.8 

2,421 

5.8 

11.7 

1907 

4,388 

10.2 

20.8 

2,590 

6.0 

12.3 

1908 

5,250 

11.2 

22.9 

3,023 

6.5 

13.2 

1909 

5,714 

11.2 

23.0 

3,585 

7.0 

14.4 

1910 

6,147 

11.4 

23.4 

3,730 

6.9 

14.2 

1911 

6,707 

11.3 

23.3 

4,190 

7.1 

14.5 

1912 

7,089 

11.7 

24.2 

4,356 

7.2 

14.9 

1913 

7,706 

12.2 

25.2 

4.514 

7.1 

14.7 

433 


APPENDIX  F  {PART  I) 

Table  45 

Mortality  from  Cancer  of  the  Skin,  by  Sex 

United  States  Registration  Area 

1900-1913 


Total 

Males 

Females 

Deaths 

Rate  per 

Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

from 

100,000 

from 

100,000 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

Cancer 

Population 

1900 

602 

2.0 

392 

2.5 

210 

1.4 

1901 

683 

2.2 

456 

2.9 

227 

1.5 

1902 

688 

2.1 

454 

2.8 

234 

1.5 

1903 

752 

2.3 

484 

2.9 

268 

1.7 

1904 

758 

2.3 

462 

2.7 

296 

1.8 

1905 

818 

2.4 

539 

3.1 

279 

1.7 

1906 

984 

2.3 

656 

3.1 

328 

1.6 

1907 

1,121 

2.6 

724 

3.3 

397 

1.9 

1908 

1,282 

2.7 

827 

3.5 

455 

2.0 

1909 

1,492 

2.9 

988 

3.8 

504 

2.0 

1910 

1,459 

2.7 

952 

3.4 

507 

1.9 

1911 

1,619 

2.7 

1,011 

3.3 

608 

2.1 

1912 

1,743 

2.9 

1,079 

3.5 

664 

2.3 

1913 

1,725 

2.7 

1,128 

3.5 

597 

1.9 

Table  46 

Mortality  from  Cancer  of  Other  or  Not  Specified  Organs  and  Parts,  by  Sex 

United  States  Registration  Area 

1900-1913 


Total 

Males 

Females 

Deaths 

Rate  per 

Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

from 

100,000 

from 

100,000 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

Cancer 

Population 

1900 

5,510 

17.9 

2,315 

15.0 

3,195 

20.8 

1901 

5,084 

16.2 

2,225 

14.1 

2,859 

18.3 

1902 

5,087 

15.9 

2,188 

13.6 

2,899 

18.2 

1903 

5,519 

16.9 

2,475 

15.0 

3,044 

18.8 

1904 

5,302 

15.9 

2,434 

14.4 

2,868 

17.4 

1905 

5,418 

15.9 

2,490 

14.4 

2,928 

17.4 

1906 

6,365 

15.2 

2,985 

14.0 

3,380 

16.4 

1907 

6,281 

14.6 

3,012 

13.8 

3,269 

15.5 

1908 

5,755 

12.3 

3,083 

12.9 

2,672 

11.7 

1909 

5,753 

11.3 

3,297 

12.7 

2,456 

9.9 

1910 

6,394 

11.9 

3,774 

13.7 

2,620 

10.0 

1911 

6,592 

11.1 

3,950 

13.0 

2,642 

9.2 

1912 

7,065 

11.7 

4,246 

13.6 

2,819 

9.6 

1913 

7,625 

12.0 

4.729 

14.5 

2.896 

9.5 

434 


APPENDIX  F  {PART  1) 

Table  47 
Estimated  Total  Mortality  from  Cancer,  by  Organs  and  Parts 


Continental  United  States 

1900- 

1913 

Peritoneum 

Female 

Other 

Buccal 

Stomach 

Intestines 

Generative 

Female 

Organs 

Year 

Cuvity 

and  Liver 

and  Rectum 

Organs 

Breast 

Skin 

or  Parts 

1000 

1,224 

17,072 

4,343 

6,653 

3,455 

1,485 

13,697 

1901 

1,513 

17,548 

5,334 

7,219 

4,009 

1,689 

12,578 

iyo2 

1,444 

18,500 

5,535 

7.499 

4,287 

1,700 

12,577 

11)03 

1,632 

20,241 

5,271 

8,125 

4,391 

1,857 

13,636 

1904 

1,820 

21,001 

6,926 

8,488 

4,988 

1,872 

13,099 

1905 

1,950 

22,019 

6,730 

8,959 

4,911 

2,015 

13,347 

1906 

1,918 

22,313 

6,671 

8,336 

4,935 

2,005 

12,977 

1907 

1,962 

23,500 

7,235 

8,892 

5,248 

2,271 

12,732 

1908 

2,178 

24,748 

7,519 

9,961 

6,735 

2,432 

10,921 

1909 

2,535 

26,497 

8,306 

10,151 

6,369 

2,650 

10,223 

1910 

2,691 

28,141 

8,981 

10,500 

6,371 

2,492 

10,923 

1911 

2,726 

27,411 

9,193 

10,587 

6,614 

2,565 

10,408 

1912 

2,894 

29,162 

9,327 

11,164 

6,860 

2,745 

11,130 

1913 

3,007 

30,215 

10,128 

11,776 

7,021 

2,633 

11,539 

Table  48 
Population  Statistics,*  by  Age  and  Sex,  United  States  Registration  Area 

1903-1912 


1903-1912 

1903 

■1907 

1908-1912 

Ages 

Males 

Females 

Males 

Females 

Males 

Females 

Under  10 

46,012,661 

45,163,577 

18,792,745 

18,479,974 

27,219,916 

26,683,603 

10-24 

64,768,033 

64,826,435 

25,939,027 

26,470,106 

38,819,006 

38,356,330 

25-34 

41,612,738 

38,391,104 

16,873,725 

16,923,152 

24,739,013 

22,407,962 

35-44 

33,236,346 

30,097,460 

13,479,733 

12,267,433 

19,755,613 

17,830,017 

45-54 

23,174,947 

20,941,618 

9,164,393 

8,424,322 

14,010,554 

12,517,296 

55-64 

13,726,350 

13,042,648 

5,478,304 

5,341,009 

8,248,040 

7,701,539 

65-74 

7,452,085 

7,602,607 

2,946,685 

3,061,414 

4,506,400 

4,641,193 

75  and  over 

2,963,942 

3,351,230 

1,167,400 

1,336,813 

1,796,542 

2,014,417 

All  ages 

232,936,102 

223,416,569 

93,841,012 

91,304,222 

139,096,090 

132,112,347 

45  and  over 

47,317,324 

44,938,003 

18,765,782 

18,163,658 

28,561,642 

26,774,445 

•Midyear  estimates. 


435 


APPENDIX  F  {PART  I) 

Table  49 

Mortality  from  Cancer  of  All  Organs  and  Parts,  by  Age  and  Sex 

United  States  Registration  Area 

1903-1912 


Ages  at  Death 

Males 

Deaths 

from 

Cancer 

Rate  per 

100,000 

Population 

Females 
Deaths             Rate  per 
from                 100,000 
Cancer           Population 

Comp 
of  Rate  fi 

Actual 

arison 
ifferences 

Per  Cent. 

Under  10 

1,170 

2.5 

984 

2.2 

-     0.3 

12.0 

10-24 

2,028 

3.1 

1,844 

2.8 

-     0.3 

9.7 

25-34 

3,757 

9.0 

7,891 

20.6 

+  11.6 

128.9 

35-44 

10,750 

32.3 

26,779 

89.0 

+  56.7 

175.5 

45-54 

24,431 

105.4 

46,669 

222.9 

+  117.5 

111.5 

■     55-64 

35,327 

257.4 

50,393 

386.4 

+  129.0 

50.1 

65-74 

33,745 

452.8 

43,010 

565.7 

+  112.9 

24.9 

75  and  over 

18,381 

620.2 

24,601 

734.1 

+113.9 

18.4 

All  ages* 

129,784 

55.7 

202,421 

90.6 

+  34.9 

62.7 

45  and  over 

111,884 

236.5 

164,673 

366.4 

+  129.9 

54.9 

'Including  unknown  ages. 

Table  50 

Mortality  from  Cancer  of  the  Buccal  Cavity,  by  Age  and  Sex 

United  States  Registration  Area 

1903-1912 


Ages  at  Death 

Males 
Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Females 
Deaths             Rate  per 
from               100,000 
Cancer          Population 

Comparison 
of  Rate  Differences 

Actual            Per  Cent. 

Under  10 

58 

0.1 

45 

0.1 

^  , 

10-24 

79 

0.1 

49 

0.1 

,  , 

,    , 

25-34 

131 

0.3 

58 

0.2 

-  0.1 

33.3 

35-44 

640 

1.9 

135 

0.4 

-  1.5 

78.9 

45-54 

1,829 

7.9 

303 

1.4 

-  6.5 

82.3 

55-64 

2,605 

19.0 

467 

3.6 

-15.4 

81.1 

65-74 

2,565 

34.4 

565 

7.4 

-27.0 

78.5 

75  and  over 

1,732 

58.4 

538 

16.1 

-42.3 

72.4 

All  ages* 

9,652 

4.2 

2,163 

1.0 

-  3.2 

76.2 

45  and  over 

8,731 

18.5 

1,873 

4.1 

-14.4 

77.8 

*Including  unknown  ages. 


436 


APPENDIX  F  {PART  I) 

Table  51 

Mortality  from  Cancer  of  the  Stomach  and  Liver,  by  Age  and  Sex 

United  States  Registration  Area 

1903-1912 


Ages  at  Death 

Males 
Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Females 

Deaths            Rate  per 

from                100,000 

Cancer          Population 

Com 
of  Rate 

Actual 

jarison 
Differences 

Per  Cent. 

Under  10 

163 

0.3 

119 

0.2 

-   0.1 

33.3 

10-24 

299 

0.5 

256 

0.4 

-   0.1 

20.0 

25-34 

1,267 

3.1 

1,484 

3.9 

+  0.8 

25.8 

35-44 

5,224 

15.7 

5,753 

19.1 

+  3.4 

21.7 

45-54 

13,110 

56.6 

12,798 

61.1 

+  4.5 

8.0 

55-64 

19,057 

138.8 

17,805 

136.5 

-  2.3 

1.7 

65-74 

17,273 

231.8 

17,496 

230.1 

-   1.7 

0.7 

75  and  over 

7.569 

255.4 

8,911 

265.9 

+  10.5 

4.1 

All  ages* 

64,049 

27.5 

64,685 

29.0 

+  1.5 

5.5 

45  and  over 

57.009 

120.5 

57,010 

126.9 

+  6.4 

5.3 

*lncluding  unknown  ages. 

Table  52 

Mortality  from  Cancer  of  the  Peritoneum,  Intestines  and  Rectum 

by  Age  and  Sex,  United  States  Registration  Area 

1903-1912 


Ages  at  Death 

Males 
Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Females 

Deaths           Rate  per 

from               100,000 

Cancer        Population 

Comparison 
of  Rate  Differences 

Actual           Per  Cent. 

Under  10 

127 

0.3 

79 

0.2 

-    0.1 

33.3 

10-24 

349 

0.5 

246 

0.4 

-    0.1 

20.0 

25-34 

808 

1.9 

929 

2.4 

+  0.5 

26.3 

35-44 

1,636 

4.9 

2,632 

8.8 

+  3.9 

79.6 

45-54 

3,130 

13.5 

4,684 

22.4 

+  8.9 

65.9 

55-64 

4,523 

33.0 

5,851 

44.9 

+11.9 

36.1 

65-74 

4,135 

55.5 

5,606 

73.7 

+18.2 

32.8 

75  and  over 

1,888 

63.7 

3,081 

91.9 

+28.2 

44.3 

All  ages* 

16,615 

7.1 

23,137 

10.3 

+  3.2 

45.1 

45  and  over 

13,676 

28.9 

19,222 

42.8 

+  13.9 

48.1 

'Including  unknown  ages. 


437 


APPENDIX  F  {PART  I) 

Table  53 

Mortality  from  Cancer  of  the  Female  Generative  Organs  and  Female 

Breast,  by  Age,  United  States  Registration  Area 

1903-1912 


Female  Gemerative  Organs 


Ages  at  Death 

Under  10 
10-24 
25-34 
35-44 
45-54 
55-64 
65-74 

75  and  over 

All  ages* 
45  and  over 


Deaths 
from 
Cancer 

31 

370 

2,989 

9,820 

14,900 

11,920 

6,903 

.2,756 

49,747 

36,479 


Rate  per 

100,000 

Female 

Population 

0.1 

0.6 

7.8 
32.6 
71.2 
91.4 
90.8 
82.2 

22.3 

81.2 


Female  Breast 

Rate  per 

Deaths 

100,000 

from 

Female 

Cancer 

Population 

8 

0.0 

49 

0.1 

918 

2.4 

4,583 

15.2 

7,528 

35.9 

7,046 

54.0 

5,683 

74.8 

3,836 

114.5 

29,685 

13.3 

24,093 

53.6 

•Including  unknown  ages. 

Table  54 

Mortality  from  Cancer  of  the  Skin,  by  Age  and  Sex 

United  Spates  Registration  Area 

1903-1912 


Ages  at  Death 

Males 
Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Females 
Deaths            Rate  per 
from                100,000 
Cancer         Population 

Comparison 
of  Rate  Differences 

Actual          Per  Cent 

Under  10 

42 

0.1 

39 

0.1 

.  , 

. , 

10-24 

63 

0.1 

41 

0.1 

,  , 

. , 

25-34 

88 

0.2 

55 

0.1 

-  0.1 

50.0 

35-44 

359 

1.1 

169 

0.6 

-  0.5 

45.5 

45-54 

913 

3.9 

391 

1.9 

-  2.0 

51.3 

55-64 

1,559 

11.4 

657 

5.0 

-  6.4 

56.1 

65-74 

2,138 

28.7 

1,064 

14.0 

-14.7 

51.2 

75.  and  over 

2,544 

85.9 

1,880 

56.1 

-29.8 

34.7 

All  ages* 

7,722 

3.3 

4,306 

1.9 

-   1.4 

42.4 

45  and  over 

7,1.54 

15.1 

3,992 

8.9 

-   6.2 

41.1 

•Including  unknown  ages. 


438 


APPENDIX  F  (PART  I) 

Table  55 

Mortality  from  Cancer  of  Other  or  Not  Specified  Organs  and  Parts,*  by  Age 

and  Sex,  United  States  Registration  Area 

1903-1912 


Ages  at  Death 

M.U.E3 

Deaths 

from 

Cancer 

Rate  per 

100,000 

Population 

Fem. 
Deaths 
from 
Cancer 

ILES 

Rate  per    • 

100,000 
Population 

Comparison 
of  Rate  Differences 

Actual          Per  Cent 

Under  10 

780 

1.7 

663 

1.5 

-    0.2 

11.8 

10-^4 

1,238 

1.9 

833 

1.3 

-  0.6 

31.6 

25-3-i 

1,463 

3.5 

1,458 

3.8 

+  0.3 

8.6 

35-44. 

2,891 

8.7 

3,687 

12.3 

+  3.6 

41.4 

45-54 

5,449 

23.5 

6,065 

29.0 

+  5.5 

23.4 

55-64 

7,583 

55.2 

6,647 

51.0 

-  4.2 

7.6 

65-74 

7,634 

102.4 

5,693 

74.9 

-27.5 

26.9 

75  and  over 

4.648 

156.8 

3,599 

107.4 

-49.4 

31.5 

All  agesf 

31,746 

13.6 

28,698 

12.8 

-  0.8 

5.9 

45  and  over 

25,314 

53.5 

22,004 

48.9 

-  4.6 

8.6 

'Including  cancer  of  the  male  breast, 
tincluding  unknown  ages. 


Table  56 


Mortality  from  Cancer,  Urban  and  Rural,  by  Organs  and  Parts 

United  States  Registration  States 

1908-1912 


Rate  per 

100,000 

Population 

Cancer 
Per  Cent. 

2.9 

3.6 

31.3 

38.4 

11.2 

13.7 

13.2 

16.2 

7.6 

9.4 

2.1 

2.6 

13.0 

16.1 

URBAN 

Deaths 
from 

Organ  or  Part  Cancer 

Buccal  cavity 3,627 

Stomach  and  liver 38,869 

Peritoneum,  intestines  and  rectum 13,888 

Female  generative  organs 16,377 

Breast 9,499 

Skin 2,659 

Other  or  not  specified  organs 16,223 

All  organs 101,142 

RURAL 

Buccal  ca\-ity 3,226 

Stomach  and  liver 32,518 

Peritoneum,  intestines  and  rectum 9,165 

Female  generative  organs 10,158 

Breast 7,689 

Skin 4,205 

Other  or  not  specified  organs 11,294 

All  organs 78,255 


81.3 


67.3 


100.0 


4.1 

41.6 
11.7 
13.0 
9.8 
5.4 
14.4 

100.0 


439 


APPENDIX  F  {PART  I) 

Table  57 

Proportionate  Mortality  from  Cancer,  by  Age  and  Sex 

United  States  Registration  Area 

1908-1912 


JIALES 

FEMALES 

Deaths  from 

Deaths  from 

Cancer 

Deaths  from 

Deaths  from 

Cancer 

Ages  at  Death 

All  Causes 

Cancer 

Per  Cent. 

All  Causes 

Cancer 

Per  Cent. 

Under  5 

559,943 

489 

0.1 

457,896 

436 

0.1 

6-  9 

44,712 

226 

0.5 

40,581 

167 

0.4 

10-14 

29,619 

195 

0.7 

27,239 

176 

0.6 

15-19 

50,540 

361 

0.7 

47,012 

334 

0.7 

20-24 

79,135 

632 

0.8 

68,824 

581 

0.8 

25-29 

86,620 

928 

1.1 

72,500 

1,451 

2.0 

30-34 

89,576 

1,302 

1.5 

70,275 

3,138 

4.5 

35-39 

101,203 

2,409 

2.4 

75,101 

6,151 

8.2 

40-44 

102,469 

3,844 

3.8 

71,142 

9,560 

13.4 

45-49 

109,083 

6,198 

5.7 

74,773 

12,841 

17.2 

50-54 

118,046 

8,724 

7.4 

83,094 

15,040 

18.1 

55-59 

116,007 

10,237 

8.8 

86,075 

14,990 

17.4 

60-64 

127,186 

11,627 

9.1 

101,475 

15,207 

15.0 

65-69 

133,478 

11,546 

8.7 

115,105 

14.513 

12.6 

70-74 

129,176 

9,611 

7.4 

118,788 

11,938 

10.0 

75-79 

114,101 

6,878 

6.0 

110.598 

8,700 

7.9 

80-84 

78,996 

3,381 

4.3 

84,061 

4,496 

6.3 

85-89 

40,663 

1,305 

3.2 

47,809 

1.888 

3.9 

90-94 

12,801 

299 

2.3 

17,635 

497 

2.8 

95  and  over 

3,362 

62 

1.8 

5,458 

104 

1.9 

Unknown 

3.555 

72 

•• 

1,347  . 

87 

All  ages 

2,130,271 

80,326 

3.8 

1,776,788 

122,295 

6.9 

Under  15 

634,274 

910 

0.1 

525,716 

779 

0.1 

15-44 

509,543 

9,476 

1.9 

404,854 

21,215 

5.2 

45-64 

470,322 

36,786 

7.8 

345,417 

58,078 

16.8 

65  and  over 

512,577 

33,082 

6.5 

499,454 

42,136 

8.4 

Table  58 

Relative  Mortality  from  Cancer  and    Other  Important    Causes  of  Death 

by  Age  and  Sex,  United  States  Registration  Area 

1908-1912 


All  Causes 

Typhoid  fever 

Pul.  tuberculosis 

Cancer 

Apoplexy 

Heart  diseases 

Pneumonia 

Digestive  diseases .... 

Nephritis 

Suicides 

Accidents 

•Including  unknown  ages. 


TOTAL 

All  Ages* 

Under  45 

45  AND  Over 

Per  Cent,  of  AH 

PerCent.  of  All 

Deaths 

Deaths 

Known  Ages 

Deaths 

Known  Ages 

,907.059 

2,074,387 

53.2 

1,827,770 

46.8 

57,208 

47,611 

83.4 

9,497 

16.6 

366,075 

267,167 

73.1 

98,521 

26.9 

202,621 

32,380 

16.0 

170,082 

84.0 

198,657 

17,752 

8.9 

180,698 

91.1 

421,580 

87,093 

20.7 

334,073 

79.3 

369,966 

222,493 

60.2 

147,213 

39.8 

480,614 

352,730 

73.4 

127,696 

26.6 

265,665 

63,852 

24.1 

201,590 

75.9 

44,602 

24,507 

55.2 

19,911 

44.8 

224,061 

145,328 

65.3 

77,392 

34.7 

440 


APPENDIX  F  {PART  I) 

Table  58  (concluded) 

Relative  Mortality  from  Cancer  and  Other  Important  Causes  of  Death 

by  Age  and  Sex,  United  States  Registration  Area 

1908-1912 


All  Ages* 

Deaths 

All  causes 2.130,271 

Typhoid  fever 34,206 

Pul.  tuberculosis 207,603 

Cancer 80,326 

Apoplexy 101,751 

Heart  diseases 223,934 

Pneumonia 203,946 

Digestive  diseases ....  257,919 

Nephritis 149,535 

Suicides 34,348 

Accidents 173,457 

All  causes 1,776,788 

Typhoid  fever 23,002 

Pul.  tuberculosis 158,472 

Cancer 122,295 

Apoplexy 96,906 

Heart  diseases 197,646 

Pneumonia 166,020 

Digestive  diseases  ....  222,695 

Nephritis 116,130 

Suicides 10,254 

Accidents 50,604 


MALES 

Under  45 

Per  Cent,  of  All 
Deaths  Known  Ages 

1,143,817  53.8 


28,444 
143,593 

10,386 
9,771 

44,023 
127,156 
191,583 

33,251 

17,512 
117,604 

FEMALES 

930,570 

19,167 
123,574 

21,994 
7,981 

43,070 

95,337 
161,147 

30,601 
6,995 

27,724 


83.3 
69.2 
12.9 
9.6 
19.7 
62.4 
74.3 
22.3 
51.2 
68.3 


52.4 

83.4 
78.1 
18.0 
8.2 
21.8 
57.5 
72.4 
26.4 
68.3 
54.9 


45  AND  Over 

Per  Cent,  of  All 
Deaths        Known  Ages 

982.899     46.2 


5,694 
63,791 
69,868 
91,846 

179,656 
76,637 
66,221 

116,142 
16,666 
64,588 


844,871 


16.7 
30.8 
87.1 
90.4 
80.3 
37.6 
25.7 
77.7 
48.8 
31.7 


47.6 


3,803 

16.6 

34,730 

21.9 

100,214 

82.0 

88,852 

91.8 

154,417 

78.2 

70,576 

42.5 

61,475 

27.6 

85,448 

73.6 

3,245 

31.7 

22,804 

45.1 

*Including  unknown  ages. 

Table  59 

Mortality  from  Cancer  in  the  States  of  New  York,  Massachusetts,  New 

Hampshire  and  Connecticut,  by  Months 

1902-1911 


Mean 

Months  Population* 

January 131,540,322 

February..  ..  120,069,048 

March 132,048,497 

April 128,030,367 

May 132,571,692 

June 128,540,835 

July 133,094,888 


Deaths 

Rate  per 

Deaths 

Rate  per 

from 

100,000 

Mean 

from 

100,000 

Cancer  Population 

Months 

Population* 

Cancer 

Population 

8,300 

6.3 

August 

133,360,781 

8,941 

6.7 

7,721 

6.4 

September. 

129,300,297 

8,543 

6.6 

8,600 

6.5 

October . .  . 

133,883,987 

9,017 

6.7 

8,315 

6.5 

November. . 

129,806,603 

8,477 

6.5 

8,576 

6.5 

December. . 

134,407,183 

8,804 

6.6 

8,123 

6.3 

Monthly 

8,613 

6.5 

Average  .  .  . 

130,554,542 

8,503 

6.5 

*Population  has  been  standardized  for  variation  in  length  of  month. 


441 


APPENDIX  F  (PART  I) 

Table  60 

Comparative  Death  Rate  from  Cancer,  1901  and  1911,  according  to  Age  and 

Sex,  in  the  States  Included  in  the  Registration  Area  in  1900* 

Rate  per  100,000  Population 


Total 

Per  Cent.  Which 

Rate  in  1911 

Age  Period 

1901 

1911 

Represents  of 
That  in  1901 

All  ages : 

Crude  rate 

65.8 
62.2 

83.9 

77.6 

128 

Standardized  ratef 

125 

Under  5  years .... 

3.4 

3.0 

88 

5-  9  years . 

1.0 

1.2 

120 

10-14     "     . 

0.9 

1.3 

144 

15-19     "     . 

2.1 

2.3 

110 

20-24     "     . 

3.9 

4.8 

123 

25-34     "     . 

13.4 

13.9 

104 

35-44     "     . 

60.2 

61.0 

101 

45-54     "     . 

146.5 

166.3 

114 

55-64     "     . 

268.3 

352.4 

131 

65-74     "     . 

418.8 

566.7 

135 

75  and  over. .  . 

557.6 

794.7 

143 

25  years  and  over: 

Crude  rate. ... 

124.5 
127.2 

155.7 
159.0 

125 

Standardized  n 

itef 

125 

Males 

Per  Cent. 

Which  Rate 

in  1911 

Females 

Per  Cent. 

Which  Rate 

in  1911 

Age  Period 

1901 

1911 

Represents  of 
That  b  1901 

Age  Period 

1901 

1911 

Represents  of 
That  in  1901 

All  ages: 

All  ages: 

Crude  rate. . . 

48.7 

64.2 

132 

Crude  rate .  .  . 

83.0 

104.0 

125 

Stand'r'zedratef      43.6 

56.7 

130 

Stand'r'zedratef      79.7 

97.2 

122 

Under  5  years 

3.8 

3.1 

82 

Under  5  years 

3.1 

3.0 

97 

5-  9  years 

1.3 

1.3 

100 

5-  9  years 

0.8 

1.1 

138 

10-14     " 

0.9 

1.0 

111 

10-14     " 

0.9 

1.5 

167 

15-19     " 

1.9 

2.9 

153 

15-19     "    . 

2.2 

1.7 

77 

20-24     " 

3.3 

4.9 

148 

20-24     " 

4.5 

4.6 

102 

25-34     " 

9.4 

8.7 

93 

25-34      " 

17.5 

19.4 

111 

35-44     " 

32.5 

31.1 

96 

35-44     " 

89.6 

92.5 

103 

45-54     " 

.       90.0 

109.2 

121 

45-54     " 

.     205.4 

227.0 

111 

55-64     " 

.      203.8 

283.4 

139 

55-64     " 

.     331.8 

422.3 

127 

65-74     " 

.      366.0 

512.8 

140 

65-74     " 

.     468.9 

617.8 

132 

75  and  over. . 

.     520.8 

730.5 

140 

75  and  over. . 

.     589.8 

848.7 

144 

25  years  and  o-^ 

•er: 

25  years  and  o 

ver: 

Crude  rate..  . 

90.9 

117.7 

129 

Crude  rate. . . 

.      158.7 

195.0 

123 

Stand'r'zedrat 

et      90.4 

117.9 

130 

Stand'r'zedrat 

ef    160.3 

195.9 

122 

•Includes  Connecticut,  the  District  of   Columbia,  Indiana,  Maine,  Massachusetts,  Michigan,  New  Hamp- 
shire, New  Jersey,  New  York,  Rhode  Island  and  Vermont. 

fStandardized  on  basis  of  standard  million  of  England  and  Wales,  1901. 


442 


APPENDIX  F  (PART  I) 

Table  61 

Mortality  from  Cancer  of  All  Organs  and  Parts,  according  to  Age 

United  States  Registration  Area 

1903-1907  Compared  with  1908-1912 

Males 


1903-1907 

1908 

1912 

Increase  ob 

Decrease 

Deaths 

Rate  per 

Deaths 

Rate  per 

Ages  at  Death 

from 

100,000 

from 

100,000 

Actual 

Per  Cent. 

Cancer 

Population 

Cancer 

Population 

Under  10 

455 

2.4 

715 

2.6 

+      0.2 

8.3 

10-24 

840 

3.2 

1,188 

3.1 

-     0.1 

3.1 

25-34 

1,527 

9.0 

2,230 

9.0 

35-44 

4,497 

33.4 

6,253 

31.7 

-     1.7 

5.1 

45-54 

9,509 

103.8 

14,922 

106.5 

+     2.7 

2.6 

55-64 

13,463 

245.7 

21,864 

265.1 

+  19.4 

7.9 

65-74 

12,588 

427.4 

21,157 

469.5 

+  42.1 

9.9 

75  and  over 

6,466 

553.9 

11,915 

663.2 

+109.3 

19.7 

All  ages* 

49.458 

52.7 

80,326 

57.7 

+     5.0 

9.5 

45  and  over 

42,026 

224.1 

69,858 

244.6 

+  20.5 

9.1 

'Including  unknown  ages. 

Table  62 

Mortality  from  Cancer  of  All  Organs  and  Parts,  according  to  Age 

United  States  Registration  Area 

1903-1907  Compared  with  1908-1912 

Females 


1903-1907 

1908-1912 

Increase  or 

Decreasb 

Deaths 

Rate  per 

Deaths 

Rate  per 

Ages  at  Death 

from 

100,000 

from 

100,000 

Actual 

Per  Cent. 

Cancer 

Population 

Cancer 

Population 

Under  10 

381 

2.1 

603 

2.3 

+     0.2 

9.5 

10-24 

753 

2.8 

1,091 

2.9 

+     0.1 

3.6 

25-34 

3,302 

20.7 

4,589 

20.4 

-     0.3 

1.4 

35-44 

11,068 

90.2 

15,711 

88.1 

-     2.1 

2.3 

45-54 

18,788 

223.0 

27.881 

222.7 

-     0.3 

0.1 

55-64 

20,196 

378.1 

30,197 

392.1 

+  14.0 

3.7 

65-74 

16,559 

540.9 

26,451 

582.5 

+  41.6 

7.7 

75  and  over 

8,916 

667.0 

15.685 

778.6 

-i-111.6 

16.7 

All  ages* 

80,126 

87.8 

122,295 

92.6 

+     4.8 

5.5 

45  and  over 

64,459 

354.9 

100,214 

374.3 

+  19.4 

5.5 

•Including  unknown  ages. 


443 


APPENDIX  F  {PART  I) 

Table  63 

Mortality  from  Cancer  of  the  Buccal  Cavity,  according  to  Age 

United  States  Registration  Area 

1903-1907  Compared  with  1908-1912 

Males 


1903-1907 

1908-1912 

InCEEASE   OB 

Decbease 

Deaths 

Rate  oer 

Deaths 

Rate  per 

Ages  at  Death 

from 

100,000 

from 

100,000 

Actual 

Per  Cent. 

Cancer 

Population 

Cancer 

Population 

Under  10 

18 

0.1 

40 

0.1 

+  0.05 

50.0 

10-24 

33 

0.1 

46 

0.1 

-   0.01 

7.7 

25-34 

54 

0.3 

77 

0.3 

-   0.01 

3.1 

35-44 

261 

1.9 

379 

1.9 

-  0.02 

1.0 

45-54 

649 

7.1 

1,180 

8.4 

+  1.34 

18.9 

55-64 

908 

16.6 

1,697 

20.6 

+  4.00 

24.1 

65-74 

865 

29.4 

1,700 

37.7 

+  8.36 

28.5 

75  and  over 

516 

44.2 

1,216 

67.7 

-f  23.49 

53.1 

All  ages* 

3,311 

3.5 

6,341 

4.6 

+  1.03 

29.2 

45  and  over 

2,938 

15.7 

5,793 

20.3 

+  4.62 

29.5 

•Including  unknown  ages. 

Table  64 

Mortality  from  Cancer  of  the  Buccal  Cavity,  according  to  Age 

United  States  Registration  Area 

1903-1907  Compared  with  1908-1912 

Females 


1903-1907 

1908-191'2 

InCBEASE  OB 

Decbease 

Deaths 

Rate  per 

Deaths 

Rate  per 

Ages  at  Death 

from 

100,000 

from 

100,000 

Actual 

Per  Cent. 

Cancer 

Population 

Cancer 

Population 

Under  10 

19 

0.1 

26 

0.1 

,  , 

,    , 

10-24 

11 

0.0 

38 

0.1 

-fO.06 

150.0 

2.5-34 

25 

0.1 

33 

0.1 

-0.01 

6,3 

35-44 

54 

0.4 

81 

0.4 

-j-0.01 

2.3 

45-54 

121 

1.4 

182 

1.4 

-j-0.01 

0.7 

55-64 

195 

3.6 

272 

3.5 

-0.12 

3.3 

65-74 

207 

6.8 

358 

7.9 

-fl.l2 

16.6 

75  and  over 

156 

11.7 

382 

19.0 

+7.29 

62.5 

All  ages* 

788 

0.9 

1,375 

1.0 

+0.18 

20.9 

45  and  over 

679 

3.7 

1,194 

4.5 

+0.72 

19.3 

'Including  unknown  ages. 


444 


APPENDIX  F  {PART  I) 

Table  65 

Mortality  from  Cancer  of  the  Stomach  and  Liver,  according  to  Age 

United  States  Registration  Area 

1903-1907  Compared  with  1908-1912 

Males 


1903-1907 

1908-1912 

Increase  ob 

Decrease 

Deaths 

Rate  per 

Deaths 

Rate  per 

Ages  at  Death 

from 

100,000 

from 

100,000 

Actual 

Per  Cent. 

Cancer 

Population 

Cancer 

Population 

Under  10 

65 

0.3 

98 

0.4 

+  0.1 

33.3 

10-24 

120 

0.5 

179 

0.5 

25-34 

509 

3.0 

758 

3.1 

+  0.1 

3.3 

35-44 

2,185 

16.2 

3,039 

15.4 

-  0.8 

4.9 

45-54 

5,046 

55.1 

8,064 

57.6 

+  2.5 

4.5 

55-64 

7,096 

129.5 

11,961 

145.0 

+  15.5 

12.0 

65-74 

6,350 

215.6 

10,923 

242.4 

+26.8 

12.4 

75  and  over 

2,558 

219.1 

5,011 

278.9 

+59.8 

27.3 

All  ages* 

23,987 

25.6 

40,062 

28.8 

+  3.2 

12.5 

45  and  over 

21,050 

112.2 

35,959 

125.9 

+  13.7 

12.2 

*Including  unknown  ages. 

Table  66 

Mortality  from  Cancer  of  the  Stomach  and  Liver,  according  to  Age 

United  States  Registration  Area 

1903-1907  Compared  with  1908-1912 

Females 


1903-1907 

1908-1912 

Increase  or 

Decrease 

Deaths 

Rate  per 

Deaths 

Rate  per 

Ages  at  Death 

from 

100,000 

from 

100,000 

Actual 

Per  Cent. 

Cancer 

Population 

Cancer 

Population 

Under  10 

46 

0.3 

73 

0.3 

10-24 

107 

0.4 

149 

0.4 

25-34 

619 

3.9 

865 

3.8 

-  o.i 

2.6 

35-44 

2,346 

19.1 

3,407 

19.1 

45-54 

4,989 

59.2 

7,809 

62.4 

+  3.2 

5.4 

55-64 

6,727 

125.9 

11,078 

143.9 

+  18.0 

14.3 

65-74 

6,488 

211.9 

11,008 

242.4 

+30.5 

14.4 

75  and  over 

3,069 

229.6 

5,842 

290.0 

+60.4 

26.3 

All  ages* 

24,431 

26.8 

40,254 

30.5 

+  3.7 

13.8 

45  and  over 

21,273 

117.1 

35,737 

133.5 

+16.4 

14.0 

'Including  unknown  ages. 


445 


APPENDIX  F  (PART  I) 

Table  67 

Mortality  from  Cancer  of  the  Peritoneum,  Intestines  and  Rectum 

according  to  Age,  United  States  Registration  Area 

1903-1907  Compared  with  1908-1912 

Males 


1903-1907 

1908-1912 

Increase  or 

Decrease 

Deaths 

Rate  per 

Deaths 

Rate  per 

Ages  at  Death 

from 

100,000 

from 

100,000 

Actual 

Per  Cent. 

Cancer 

Population 

Cancer 

Population 

Under  10 

47 

0.3 

80 

0.3 

.  . 

10-24 

141 

0.5 

208 

0.6 

+  0.1 

20.6 

25-34 

308 

1.8 

500 

2.0 

-1-  0.2 

11.1 

35-44 

615 

4.6 

1,021 

5.2 

+  0.6 

13.0 

45-54 

1,149 

12.5 

1,981 

14.1 

+  1.6 

12.8 

55-64 

1,617 

29.5 

2,906 

35.2 

-1-  5.7 

19.3 

65-74 

1,408 

47.8 

2,727 

60.5 

-fl2.7 

26.6 

75  and  over 

613 

52.5 

1,275 

71.0 

+18.5 

35.2 

All  ages* 

5,899 

6.3 

10,716 

7.7 

+  1.4 

22.2 

45  and  over 

4,787 

25.5 

8,889 

31.1 

+  5.6 

22.0 

*Including  unknown  ages. 

Table  68 

Mortality  from  Cancer  of  the  Peritoneum,  Intestines  and  Rectum 

according  to  Age,  United  States  Registration  Area 

1903-1907  Compared  with  1908-1912 

Females 


1903-1907 

1908-1912 

Increase  or 

Decrease 

Deaths 

Plate  per 

Deaths 

Rate  per 

Ages  at  Death 

from 

100,000 

from 

100,000 

Actual 

Per  Cent. 

Cancer 

Population 

Cancer 

Population 

Under  10 

28 

0.2 

51 

0.2 

. , 

10-24 

95 

0.3 

151 

0.4 

+  0.1 

33.3 

25-34 

357 

2.2 

572 

2.5 

+  0.3 

13.6 

35-44 

1,039 

8.5 

1,593 

8.9 

+  0.4 

4.7 

45-54 

1,690 

20.1 

2,994 

23.9 

+  3.8 

18.9 

55-64 

2,115 

39.6 

3,736 

48.5 

-f  8.9 

22.5 

65-74 

1,890 

61.7 

3,716 

81.8 

+20.1 

32.6 

75  and  over 

975 

72.9 

2,106 

104.5 

+31.6 

43.3 

All  ages* 

8,209 

9.0 

14,928 

11.3 

+  2.3 

25.6 

45  and  over 

6,670 

36.7 

12,552 

46.9 

+10.2 

27.8 

'Including  unknown  ages. 


446 


APPENDIX  F  {PART  J) 

Table  69 

Mortality  frK)in  Cancer  of  the  Female  Generative  Organs 

according  to  Age,  United  States  Registration  Area 

1903-1907  Compared  with  1908-1912 


1903-1907 

1908- 

1912 

Increase  ob 

Decbease 

Deaths 

Rate  per 

Deaths 

Rate  per 

Ages  at  Death 

from 

100,000 

from 

100,000 

Actual 

Per  Cent. 

Cancer 

Population 

Cancer 

Population 

Under  10 

8 

0.0 

23 

0.1 

+  0.1 

125.0 

10-24 

134 

0.5 

236 

0.6 

+  0.1 

20.0 

25-34 

1,158 

7.3 

1,831 

8.2 

+  0.9 

12.3 

35-44 

3,836 

31.3 

5,984 

33.6 

+  2.3 

7.3 

45-54 

5,810 

69.0 

9,090 

72.6 

+  3.6 

5.2 

55-64 

4,529 

84.8 

7,391 

96.0 

+  11.2 

13.2 

65-74 

2,440 

79.7 

4,463 

98.3 

+  18.6 

23.3 

75  and  over 

886 

66.3 

1,870 

92.8 

+26.5 

40.0 

All  ages* 

18,840 

20.6 

30,907 

23.4 

+  2.8 

13.6 

45  and  over 

13,665 

75.3 

22,814 

85.2 

+  9.9 

13.1 

•Including  unknown  ages. 

Table  70 

Mortality  from  Cancer  of  the  Female  Breast,  according  to  Age 

United  States  Registration  Area 

1903-1907  Compared  with  1908-1912 


1903-1907 

1908-1912 

Increase  ob 

Decrease 

Deaths 

Rate  per 

Deaths 

Rate  per 

Ages  at  Death 

from 

100,000 

from 

100,000 

Actual 

Per  Cent. 

Cancer 

Population 

Cancer 

Population 

Under  10 

8 

0.0 

,  , 

,  , 

10-24 

is 

o.i 

34 

0.1 

,  , 

,  , 

25-34 

343 

2.2 

575 

2.6 

+  0.4 

18.2 

35-44 

1,683 

13.7 

2,900 

16.3 

+  2.6 

19.0 

45-54 

2,667 

31.6 

4,861 

38.8 

+  7.2 

22.8 

55-64 

2,684 

50.3 

4,362 

56.6 

+  6.3 

12.5 

65-74 

2,061 

67.3 

3,622 

79.8 

+  12.5 

18.6 

75  and  over 

1,330 

99.5 

2,506 

124.4 

+24.9 

25.0 

All  ages* 

10,801 

11.8 

18,884 

14.3 

+  2.5 

21.2 

45  and  over 

8,742 

48.1 

15,351 

57.3 

+  9.2 

19.1 

•Including  unknown  ages. 


30 


447 


APPENDIX  F  (PART  I) 

Table  71 

Mortality  from  Cancer  of  the  Skin,  according  to  Age 

United  States  Registration  Area,  1903-1907  Compared  with  1908-1912 

Males 


1903-1907 

1908-1912 

Increase  or 

Decrease 

Deaths 

Rate  per 

Deaths 

Rate  per 

Ages  at  Death 

from 

100,000 

from 

100,000 

Actual 

Per  Cent. 

Cancer 

Population 

Cancer 

Population 

Under  10 

8 

0.0 

34 

0.1 

+  0.08 

200.0 

10-24 

13 

0.1 

50 

0.1 

+  0.08 

160.0 

25-34 

33 

0.2 

55 

0.2 

+  0.02 

100.0 

35-44 

143 

1.1 

216 

1.1 

+  0.03 

2.8 

45-54 

353 

3.9 

560 

4.0 

+  0.15 

3.9 

55-64 

610 

11.1 

949 

11.5 

+  0.38 

3.4 

65-74 

795 

27.0 

1,343 

29.8 

+  2.81 

■  10.4 

75  and  over 

903 

77.4 

1,641 

91.3 

+13.99 

18.1 

All  ages* 

2,865 

3.0 

4,857 

3.5 

+  0.44 

14.4 

45  and  over 

2,661 

14.2 

4,493 

15.7 

+  1.54 

10.9 

'Including  unknown  ages. 

Table  72 

Mortality  from  Cancer  of  the  Skin,  according  to  Age 

United  States  Registration  Area,  1903-1907  Compared  with  1908-1912 

Females 


1903-1907 

1908-1912 

Increase  or 

Decrease 

Deaths 

Rate  per 

Deaths 

Rate  per 

Ages  at  Death 

from 

100,000 

from 

100,000 

Actual 

Per  Cent. 

Cancer 

Population 

Cancer 

Population 

Under  10 

9 

0.0 

30 

0.1 

+  0.06 

120.0 

10-24 

18 

0.1 

23 

0.1 

-  0.01 

14.3 

25-34 

28 

0.2 

27 

0.1 

-  0.06 

33.3 

35-44 

66 

0.5 

103 

0.6 

+  0.04 

7.4 

45-54 

158 

1.9 

233 

1.9 

-  0.02 

1.1 

55-64 

272 

5.1 

385 

5.0 

-  0.09 

1.8 

65-74 

387 

12.7 

677 

14.9 

+  2.27 

18.0 

75  and  over 

626 

46.8 

1,254 

62.3 

+15.42 

32.9 

All  ages* 

1,568 

1.7 

2,738 

2.1 

+  0.35 

20.3 

45  and  over 

1,443 

8.0 

2.549 

9.5 

+  1.58 

19.9 

•Including  unknown  ages. 


448 


APPENDIX  F  (PART  1) 

Table  73 

Mortality  from  Cancer  of  Other  or  Not  Specified  Organs  and  Parts* 

according  to  Age 

United  States  Registration  Area,  1903-1907  Compared  with  1908-1912 

Males 


1903-1907 

1908-1912 

Increase  or 

Dechease 

Deaths 

Rate  per 

Deaths 

Rate  per 

Ages  at  Death 

from 

100,000 

from 

100,000 

Actual 

Per  Cent. 

Cancer 

Population 

Cancer 

Population 

Under  10 

317 

1.7 

463 

1.7 

10-24 

533 

2.0 

705 

1.8 

-0.2 

10.6 

25-34 

623 

3.7 

840 

3.4 

-0.3 

8.1 

35^4 

1,293 

9.6 

1,598 

8.1 

-1.5 

15.6 

45-54 

2,312 

25.2 

3,137 

22.4 

-2.8 

11.1 

55-64 

3,232 

59.0 

4,351 

52.8 

-6.2 

10.5 

65-74 

3,170 

107.6 

4,464 

99.1 

-8.5 

7.9 

75  and  over 

1,876 

160.7 

2,772 

154.3 

-6.4 

4.0 

All  agesf 

13,396 

14.3 

18.350 

13.2 

-1.1 

7.7 

45  and  over 

10,590 

56.5 

14,724 

51.6 

-4.9 

8.7 

•Including  cancer  of  the  male  breast, 
tincluding  unknown  ages. 

Table  74 

Mortality  from  Cancer  of  Other  or  Not  Specified  Organs  and  Parts* 

according  to  Age 

United  States  Registration  Area,  1903-1907  Compared  with  1908-1912 

Females 


1903-1907 

1908-1912 

Increase  or 

Decrease 

Deaths 

Rate  per 

Deaths 

Rate  per 

Ages  at  Death 

from 

100,000 

from 

100,000 

Actual 

Per  Cent. 

Cancer 

Population 

Cancer 

Population 

Under  10 

271 

1.5 

392 

1.5 

10-24 

373 

1.4 

460 

1.2 

-  6.2 

14.3 

25-34 

772 

4.8 

686 

3.1 

-   1.7 

35.4    . 

35-44 

2,044 

16.7 

1,643 

9.2 

-  7.5 

44.9 

45-54 

3,353 

39.8 

2,712 

21.7 

-18.1 

45.5 

55-64 

3,674 

68.8 

2,973 

38.6 

-30.2 

43.9 

65-74 

3,086 

100.8 

2,607 

57.4 

-43.4 

43.1 

75  and  over 

1,874 

140.2 

1,725 

85.6 

-54.6 

38.9 

All  agesf 

15,489 

17.0 

13,209 

10.0 

-  7.0 

41.2 

45  and  over 

11,987 

66.0 

10,017 

37.4 

-28.6 

43.3 

•Including  cancer  of  the  male  breast, 
tincluding  unknown  ages. 


449 


APPENDIX  F  {PART  II) 


PART  II 

Cancer  Mortality  Statistics  of  States  and  Cities  of 
THE  United  States 

Table  State  Period  Title  Page 

1  Connecticut 1875-1913 Persons 455 

2  Connecticut 1879-1913 Males 456 

3  Connecticut 1879-1913 Females 457 

4  Maine 1892-1913 Persons 458 

5  Maine 1892-1913 Males 458 

6  Maine 1892-1913 Females 459 

7  Massachusetts 1856-1913 Persons 460 

8  Massachusetts 1856-1913 Males 461 

9  Massachusetts 1856-1913 Females 462 

10  New  Hampshire 1884-1913 Persons 463 

11  New  Hampshire 1887-1913 Males 463 

12  New  Hampshire 1887-1913 Females 464 

13  New  Jersey 1879-1913 Persons 465 

14  New  York 1885-1914 Persons 466 

15  Rhodelsland 1871-1913 Persons 467 

16  Rhode  Island 1871-1913 Males 468 

17  Rhode  Island 1871-1913 Females 469 

18  Vermont 1871-1913 Persons 470 

19  Vermont 1871-1896 Males 471 

20  Vermont 1871-1896 Females 471 

21  New  England  States,  New  York 

and  New  Jersey 1886-1913 Persons 472 

City 

22  Twenty  Large  American  Cities .  .  1881-1913 Persons 473 

23  Southern  Cities 1891-1914 White 474 

24  Southern  Cities 1891-1914 Colored 474 

25  Augusta,  Ga 1891-1913 Persons 475 

26  Augusta,  Ga 1891-1912 Males 475 

27  Augusta,  Ga 1891-1912 Females 476 

28  Baltimore,  Md 1871-1914 Persons 477 

29  Baltimore,  Md 1891-1914 White 478 

30  Baltimore,  Md 1891-1914 Colored 478 

31  Baltimore,  Md 1893-1902—1903-1912  By  Organs  and  Parts  479 

32  Boston,  Mass 1881-1914 Persons 479 

33  Boston,  Mass 1881-1913 Males 480 

34  Boston,  Mass 1881-1913 Females 481 

35  Boston,Mass 1903-1912 ByAgeandSex 482 

36  Boston,  Mass 1903-1912 By  Organs  and  Parts, 

according  to  Sex 482 

37  ]{oston.  Mass 1903-1912 By  Organs  and  Parts, 

according     to     Age, 

Males 483 

450 


APPENDIX  F  {PART  II) 

Table                                  City                                         Period                                                      Title  Page 

38  Boston,  Mass 1903-1912 By  Organs  and  Parts, 

according      to      Age, 

Females 483 

39  Brooklyn,  N.  Y 1871-1913 Persons 484 

40  Brooklyn,  N.  Y 1872-1878—1903-1913  Males 485 

41  Brooklyn,  N.  Y 1872-1878—1903-1913  Females 485 

42  Buffalo,  N.  Y 1886-1913 Persons 486 

43  Buffalo,  N.  Y 1904-1905—1908-1913  By  Sex 486 

44  Charleston,  S.  C 1881-1914 Persons 487 

45  Charleston,  S.  C 1881-1914 White 488 

46  Charleston,  S.  C 1881-1914 Colored 489 

47  Chicago,  111 1871-1913 Persons 490 

48  Chicago,  111 1895-1913 Males 491 

49  Chicago,  111 1895-1913 Females 491 

60     Chicago,  111 1903-1912.  .• By  Organs  and  Parts, 

according  to  Sex 492 

51  Cincinnati,  Ohio 1871-1913 Persons 492 

52  Cincinnati,  Ohio 1891-1913 Males 493 

53  Cincinnati,  Ohio 1891-1913 Females 493 

54  Cleveland,  Ohio 1884-1913 Persons 494 

55  Cleveland,  Ohio 1885-1913 Males 495 

56  Cleveland,  Ohio 1885-1913 Females 495 

57  Cleveland,  Ohio 1903-1912 By  Organs  and  Parts, 

according  to  Sex 496 

58  Columbus,  Ohio 1900-1913 Persons 496 

59  Dayton,  Ohio 1871-1913 Persons 497 

60  Dayton,  Ohio 1876-1908 Males 498 

61  Dayton,  Ohio 1876-1908 Females 499 

62  Denver,  Colo 1892-1913 Persons 500 

63  Denver,  Colo 1905-1913 By  Sex 500 

64  Denver,  Colo 1905-1912 By  Organs  and  Parts, 

according  to  Sex 501 

65  Detroit,  Mich 1883-1913 Persons 501 

66  Hartford,  Conn 1881-1913 Persons 502 

67  Hartford,  Conn 1886-1913 Males 503 

68  Hartford,  Conn 1886-1913 Females 503 

69  Hoboken,  N.  J 1880-1913 Persons 504 

70  Hoboken,  N.  J 1902-1913 By  Sex 504 

71  Indianapohs,  Ind 1900-1913 Persons 505 

72  Indianapohs,  Ind 1906-1913 By  Sex 505 

73  Jersey  City,  N.  J 1879-1913 Persons 506 

74  Jersey  City,  N.  J 1902-1913 By  Sex 507 

75  Kansas  City,  Mo 1900-1913 Persons 507 

76  Los  Angeles,  Cal 1900-1913 Persons 508 

77  Louisville,  Ky 1890-1913 Persons 508 

78  Memphis,  Tenn 1891-1914 Persons 509 

79  Memphis,  Tenn 1891-1914 White 509 

80  Memphis,  Tenn 1891-1914 Colored 510 

81  Milwaukee,  Wis 1894-1913 Persons 510 

82  Milwaukee,  Wis 1898-1913 Males 511 

451 


APPENDIX  F  {PART  II) 

Table                                  City                                      Period                                                   Title  Page 

83  Milwaukee,  Wis 1898-1913 Females 511 

84  Minneapolis,  Minn 1889-1913 Persons 512 

85  Minneapolis,  Minn 1908-1912 By  Organs  and  Parts, 

according  to  Sex 512 

86  Minneapolis,  Minn 1908-1912 By  Organs  and  Parts, 

according  to  Age 513 

87  Nashville,  Tenn 1879-1914 Persons 513 

88  Nashville,  Tenn 1885-1913 Males 514 

89  Nashville,  Tenn 1885-1913 Females 514 

90  Nashville,  Tenn 1885-1914 Wliite 515 

91  Nashville,  Tenn 1885-1914 Colored 516 

92  Nashville,  Tenn 1903-1912 By  Organs  and  Parts, 

according  to  Sex .....  516 

93  Newark,N.J 1859-1913 Persons 517 

94  Newark,  N.  J 1902-1913 By  Sex 518 

95  New  Haven,  Conn 1880-1913 Persons 518 

96  New  Haven,  Conn 1880-1913 Males 519 

97  New  Haven,  Conn 1880-1913 Females 520 

98  New  Orleans,  La 1871-1914 Persons 521 

99  New  Orleans,  La 1877-1914 ^Vhite 522 

100  New  Orleans,  La 1877-1914 Colored 523 

101  New  Orleans,  La 1901-1913 By  Sex 524 

102  New  Orleans,  La 1904-1913 By  Organs  and  Parts, 

according  to  Race. ...     525 

103  New  Orleans,  La 1904-1913 By  Organs  and  Parts, 

according  to  Sex  and 
Race 525 

104  New  Orleans,  La.,  Charity  Hospi- 

tal  1908-1912 By  Organs  and  Parts, 

White 526 

105  New  Orleans,  La.,  Charity  Hospi- 

tal  1908-1912 By  Organs  and  Parts, 

Colored 529 

106  Greater  New  York,  N.  Y 1891-1914 Persons 532 

107  Greater  New  York,  N.  Y 1891-1913 Males 532 

108  Greater  New  York,  N.  Y 1891-1913 Females 533 

109  Greater  New  York,  N.  Y 1893-1912 By  Age 533 

110  Greater  New  York,  N.  Y 1893-1912 By  Age,  Males 534 

111  Greater  New  York,  N.  Y 1893-1912 By  Age,  Females 534 

112  Greater  New  York,  N.  Y 1903-1912 Buccal     Cavity,     ac- 

cording to  Sex 535 

113  Greater  New  York,  N.  Y 1903-1912 Stomach   and   Liver, 

according  to  Sex 535 

114  Greater  New  York,  N.  Y 1903-1912 Peritoneum,Intestines 

and  Rectum,  accord- 
ing to  Sex 536 

115  Greater  New  York,  N.  Y 1903-1912 Female       Generative 

Organs 536 

116  Greater  New  York,  N.  Y 1903-1912 Female  Breast 536 

117  Greater  New  York,  N.  Y 1903-1912 Skin,  according  to  Sex  537 

118  Greater  New  York,  N.  Y 1903-1912 Other  or  Not  Specified 

Organs,  according  to 

Sex 537 

452 


APPENDIX  F  {PART  II) 

Table  City  Period  Title  Page 

119  Greater  New  York,  N.  Y 1903-1907—1908-1912  By  Organs  and  Parts     538 

120  Greater  New  York,  N.  Y 1903-1907—1908-1912  By  Organs  and  Parts, 

according  to  Sex.  .  . .     538 

121  Greater  New  York,  N.  Y 1903-1912 By  Boroughs,  accord- 

ing to  Sex 539 

122  Manhattan  and  Bronx,  N.  Y.  C .  .  1871-1913 Persons 540 

123  Manhattan  and  Bronx,  N.  Y.  C .  .  1871-1913 Males 541 

124  Manhattan  and  Bronx,  N.  Y,  C .  .  1871-1913 Females 542 

125  Omaha,  Neb 1900-1913 Persons 542 

126  Philadelphia,  Pa 1861-1914 Persons 543 

127  Philadelphia,  Pa 1861-1914 Males 544 

128  Philadelphia,  Pa 1861-1914 Females 545 

129  Philadelphia,  Pa 1878-1903* By  Organs  and  Parts, 

according  to  Sex 546 

130  Philadelphia,  Pa 1891-1902—1903-1912  By  Organs  and  Parts     546 

131  Philadelphia,  Pa 1881-1912 Buccal     Cavity,     ac- 

cording to  Age 547 

132  Philadelphia,  Pa 1881-1912 Stomach   and    Liver, 

according  to  Age 547 

133  Philadelphia,  Pa 1881-1912 Peritoneum,Intestines 

and  Rectum,  accord- 
ing to  Age 548 

134  Philadelphia,  Pa 1881-1912 Generative      Organs, 

according  to  Age 548 

135  Philadelphia,  Pa 1881-1912 Breast,   according  to 

Age 549 

136  Philadelphia,  Pa 1881-1912 Skin,  according  to  Age    549 

137  Philadelphia,  Pa 1881-1912 Other  or  Not  Specified 

Organs,  according  to 

Age 550 

138  Philadelphia,  Pa 1881-1912 According  to  Age 550 

139  Pittsburgh,  Pa 1888-1913 Persons 551 

140  Pittsburgh,  Pa 1888-1899—1910-1913  Males 551 

141  Pittsburgh,  Pa 1888-1899—1910-1913  Females. 552 

142  Pittsburgh,  Pa 1893-1902—1903-1912  According  to  Age 552 

143  Pittsburgh,  Pa 1888-1899 By  Organs  and  Parts, 

according  to  Age 553 

144  Pittsburgh,  Pa 1888-1899 By  Organs  and  Parts, 

according  to  Sex 553 

145  Pittsburgh,  Pa 1910-1913 By  Organs  and  Parts, 

according  to  Sex 554 

146  Pittsburgh,  Pa 1888-1899—1910-1913  By  Organs  and  Parts, 

according  to  Sex ....  554 

147  Providence,  R.  1 1881-1914 Persons 555 

148  Providence,  R.  1 1881-1914 Males 556 

149  Providence,  R.  1 1881-1914 Females 557 

150  Providence,  R.  1 1903-1912 By  Organs  and  Parts, 

according  to  Sex 557 

151  Richmond,  Va 1879-1914 Persons 558 

152  Richmond,  Va 1882-1913 Males 559 

153  Richmond,  Va 1882-1913 Females 559 

154  Richmond,  Va 1879-1914 White 560 

•Excluding  1897-1898. 

453 


APPENDIX  F  {PART  II) 

Table                               City                                       Period                                                     Title  Page 

155  Richmond,  Va 1879-1914 Colored 560 

156  Richmond,  Va 1903-1912 By  Organs  and  Parts, 

according  to  Sex 561 

157  Rochester,  N.  Y 1891-1913 Persons 561 

158  Rochester,  N.  Y 1900-1913 BySex 562 

159  San  Francisco,  Cal 1884-1913 Persons 562 

160  San  Francisco,  Cal 1884-1913 Males 563 

161  San  Francisco,  Cal 1884-1913 Females 564 

162  San  Francisco,  Cal 1906-1913 By  Organs  and  Parts, 

according  to  Sex 564 

163  San  Francisco,  Cal 1906-1911 By  Age,  according  to 

Sex 565 

164  Savannah,  Ga 1881-1914 Persons 565 

165  Savannah,  Ga 1881-1914 White 566 

166  Savannah,  Ga 1881-1914 Colored 567 

167  Seattle,  Wash 1899-1914 Persons 567 

168  Seattle,  Wash 1901-1912 By  Organs  and  Parts.  568 

169  Springfield,  Mass 1890-1913 Persons 568 

170  Springfield,  Mass 1891-1913 Males 569 

171  Springfield,  Mass 1891-1913 Females 569 

172  Springfield,  Mass 1908-1912 By  Organs  and  Parts, 

according  to  Sex 570 

173  St.  Louis,  Mo. 1881-1913 Persons 570 

174  St.  Louis,  Mo 1887-1913 Males 571 

175  St.  Louis,  Mo 1887-1913 Females 571 

176  St.  Paul,  Minn 1885-1913 Persons 572 

177  District  of  Columbia 1879-1914 Persons 573 

178  District  of  Columbia 1879-1913 Males 574 

179  District  of  Columbia 1879-1913 Females 575 

180  District  of  Columbia 1882-1914 White 576 

181  District  of  Columbia 1882-1914 Colored 577 

182  District  of  Columbia 1901-1910 By  Organs  and  Parts, 

according     to     Age, 

White  Males 578 

183  District  of  Columbia 1901-1910 By  Organs  and  Parts, 

according     to     Age, 

White  Females 579 

184  District  of  Columbia 1901-1910 By  Organs  and  Parts, 

according     to     Age, 

Colored  Males 580 

185  District  of  Columbia 1901-1910 By  Organs  and  Parts, 

according      to      Age, 

Colored  Females ...  .  581 


454 


APPENDIX  F  {PART  II) 

Table  1 

Mortality  from  Cancer  in  the  State  of  Connecticut 

1875-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1875 

580,075 

204 

35.2 

1901 

931,055 

635 

68.2 

1902 

951,949 

624 

65.5 

1876 

588,600 

175 

29.7 

1903 

972,844 

721 

74.1 

1877 

597,125 

219 

36.7 

1904 

993,739 

669 

67.3 

1878 

605,650 

245 

40.5 

1905 

1,014,634 

747 

73.6 

1879 

614,175 

209 

34.0 

1880 

622,700 

226 

36.3 
35.5 

1901-1905 
1906 

4,864,221 
1,035,529 

3,396 
809 

69.8 

1876-1880 

3,028,250 

1,074 

78.1 

1907 

1,056,424 

809 

76.6 

1881 

635,055 

269 

42.4 

1908 

1,077,319 

791 

73.4 

1882 

647,410 

248 

38.3 

1909 

1,098,214 

876 

79.8 

1883 

659,766 

305 

46.2 

1910 

1,119,109 

896 

80.1 

1884 

672,122 

312 

46.4 

1885 

684,478 

288 

42.1 
43.1 

1906-1910 
1911 

5,386,595 
1,140,003 

4,181 
890 

77.6 

1881-1885 

3,298,831 

1,422 

78.1 

1912 

1,160,898 

937 

80,7 

1886 

696,834 

280 

40.2 

1913 

1,181,793 

1,000 

84,6 

1887 

709,190 

316 

44.6 

1888 

721,546 

348 

48.2 

Source: 

Bureau   of 

Vital  Statistics  of 

1889 

733,902 

324 

44.1 

the  State  of  Connecticul 

.,  Annual 

Registra- 

1890 

746,258 

361 

48.4 
45.2 

tion  Reports. 

1886-1890 

3,607,730 

1,629 

1891 

762,474 

417 

54.7 

1892 

778,690 

366 

47.0 

1893 

794,906 

405 

50.9 

1894 

811,122 

416 

51.3 

1895 

827,338 

471 

56.9 

52.2 

1891-1895 

3,974,530 

2,075 

1896 

843,554 

459 

54.4 

1897 

859,770 

514 

59.8 

1898 

.     875,986 

517 

59.0 

1899 

892,203 

569 

63.8 

1900 

910,161 

608 

66.8 
60.9 

1896-1900 

4,381,674 

2,667 

455 


APPENDIX  F  {PART  II) 

Table  2 

Mortality  from  Cancer  in  the  State  of  Connecticut,  Males 

1879-1913 


Deaths 

Rate  per 

Deaths         Rate  per 

Year 

Population 

from 

100,000 

Year            Population 

from            100,000 

Cancer 

Population 

Cancer      Population 

1879 

301,437 

60 

19.9 

1906            521,078 

314            60.3 

1880    • 

305,808 

68 

22.2 

1907  532,226 

1908  543,400 

299            56.2 
292            53.7 

1881 

312,130 

91 

29.2 

1909             554,598 

316            57.0 

1882 

318,461 

66 

20.7 

1910             565,822 

328            58.0 

1883 

1884 

324,803 
331,155 

95 
101 

29.2 
30.5 

27.4 

1906-1910     2,717,124 
1911            577,070 

1,549            57.0 

1881-1884 

1,286,549 

353 

294            50.9 

1912            588,343 

357            60.7 

1886 

343,888 

83 

24.1 

1913             599,639 

377             62.9 

1887 

350,269 

108 

30.8 

1888 

356,660 

106 

29.7 

Source:     Bureau   of 

Vital  Statistics   of 

1889 

363,061 

112 

30.8 

the  State  of  Connecticut,  Annual  Registra- 

1890 

369,547 

116 

31.4 
"      29.4 

tion  Reports. 

1886-1890 

1,783,425 

525 

1891 

377.882 

142 

37.6 

1892 

386,308 

102 

26.4 

1893 

394,750 

131 

33.2 

1894 

403,209 

137 

34.0 

1895 

411,683 

134 

32.5 
32.7 

1891-1895 

1,973,832 

646 

1896 

420,174 

159 

37.8 

1897 

428,681 

172 

40.1 

1898 

437,205 

169 

38.7 

1899 

445,745 

169 

37.9 

1900 

455,172 

217 

47.7 
40.5 

1896-1900 

2,186.977 

886 

1901 

466,086 

243 

52.1 

1902 

477,022 

207 

43.4 

1903 

487,979 

226 

46.3 

1904 

498,956 

219 

43.9 

1905 

509,955 

270 

52.9 

47.7 

1901-1905 

2,439,998 

1,165 

456 


APPENDIX  F  {PART  II) 

Table  3 

Mortality  from  Cancer  in  the  State  of  Connecticut,  Females 

1879-1913 


Year 
1879 

1880 

1881 

1882 
1883 
188J. 


Population 

312,738 
316,892 

322,925 
328,949 
334,963 
340,967 


1881-1884  1,327,804 


1886 
1887 
1888 
1889 
1890 


352,946 
358,921 
364,886 
370,841 
376,711 


Deaths 
from 
Cancer 

149 
158 

178 
182 
210 
211 

781 

197 
208 
242 
212 
245 


Rate  per 

100,000 

Population 

47.6 
49.9 

55.1 
55.3 

62.7 
61.9 

58.8 

55.8 
58.0 
66.3 

57.2 
65.0 


1886-1890 

1,824,305 

1,104 

60.5 

1891 

384,592 

275 

71.5 

1892 

392,382 

264 

67.3 

1893 

400,156 

274 

68.5 

1894 

407,913 

279 

68.4 

1895 

415,655 

337 

81.1 

1891-1895 

2,000,698 

1,429 

71.4 

1896 

423,380 

300 

70.9 

1897 

431,089 

342 

79.3 

1898 

438,781 

348 

79.3 

1899 

446,458 

400 

89.6 

1900 

454,989 

391 

85.9 

1896-1900 

2,194,697 

1,781 

81.2 

1901 

464,969 

392 

84.3 

1902 

474,927 

417 

87.8 

1903 

484,865 

495 

102.1 

1904 

494,783 

450 

90.9 

1905 

504,679 

477 

94.5 

1901-1905 

2,424,223 

2,231 

92.0 

Year 

1906 
1907 
1908 
1909 
1910 


Population 

514,451 
524,198 
533,919 
543,616 

553,287 


Deaths 
from 
Cancer 

495 
510 
499 
560 
568 


1906-1910     2,669,471         2,632 


1911 
1912 
1913 


562,933 
572,555 
582,154 


596 
580 
623 


Rate  per 

100,000 

Population 

96.2 

97.3 

93.5 

103.0 

102.7 

98.6 

105.9 
101.3 
107.0 


Source:  Bureau  of  Vital  Statistics  of 
the  State  of  Connecticut,  Annual  Registra- 
tion Reports. 


457 


APPENDIX  F  (PART  II) 

Table  4 

Mortality  from  Cancer  in  the  State  of  Maine 

1892-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1892 

667,762 

404 

60.5 

1906 

723,976 

617 

85.2 

1893 

671,100 

433 

64.5 

1907 

728,827 

737 

101.1 

1894 

674,438 

474 

70.3 

1908 

733,678 

710 

96.8 

1895 

677,776 

480 

70.8 

1909 

738,530 

727 

98.4 

1910 

743,382 

762 

102.5 

1892-1895 

2,691,076 

1,791 

66.6 

1906-1910 

3,668,393 

3,553 

96.9 

1896 

681,114 

518 

76.1 

1897 

684,452 

463 

67.6 

1911 

748,233 

738 

98.6 

1898 

687,790 

531 

77.2 

1912 

753,085 

828 

109.9 

1899 

691,128 

541 

78.3 

1913 

757,936 

838 

110.6 

1900 

694,870 

526 

75.7 

Source: 

Annual     Reports 

upon     the 

1896-1900 

3,439.354 

2,579 

75.0 

Births,   Marriages,   Divorces  and  Deaths 

in  the  State  of  Maine. 

1901 

699,721 

570 

81.5 

1902 

704,572 

615 

87.3 

1903 

709,423 

598 

84.3 

1904 

714,274 

611 

85.5 

1905 

719,125 

662 

92.1 

86.2 

1901-1905 

3,547,115 

3,056 

Table  5 

Mortality  from  Cancer  in  the  State  of  Maine,  Males 

1892-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1892 

336,085 

150 

44.6 

1906 

366.911 

238 

64.9 

1893 

337,899 

170 

50.3 

1907 

369,588 

C66 

72.0 

1894 

339,714 

177 

52.1 

1908 

372,268 

243 

65.3 

1895 

341,531 

173 

50.7 

1909 

374,952 

271 

72.3 

1910 

377,564 

260 

68  9 

1892-1895 

1,355,229 

670 

49.4 

1906-1910 

1,861,283 

1.278 

68.7 

1896 

343,350 

185 

53.9 

1897 

345,169 

188 

54.5 

1911 

380,177 

254 

66.8 

1898 

347,059 

197 

56.8 

1912 

382.868 

261 

68.2 

1899 

348,951 

179 

51.3 

1913 

385,637 

290 

75.2 

1900 

351,187 

188 

53.5 

Source: 

Annual     Reports 

upon     the 

1896-1900 

1,735,716 

937 

54.0 

Births,   Marriages,   Divorces  and  Deaths 

in  the  State  of  Maine. 

1901 

353,779 

199 

56.2 

1902 

356,373 

224 

62.9 

1903 

358,968 

210 

58.5 

1904 

361,565 

245 

67.8 

1905 

364,237 

238 

65.3 
62.2 

1901-1905 

1,794,922 

1,116 

458 


APPENDIX  F  {PART  II) 

Table  6 

Mortality  from  Cancer  in  the  State  of  Maine,  Females 

1892-1913 


Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Cancer 

Population 

1892 

331,677 

254 

76.6 

1893 

333,201 

263 

78.9 

1894 

334,724 

297 

88.7 

1895 

336,245 

1,335,847 

307 

91.3 

1892-1895 

1,121 

83.9 

1896 

337,764 

333 

98.6 

1897 

339,283 

275 

81.1 

1898 

340,731 

334 

98.0 

1899 

342,177 

362 

105.8 

1900 

343,683 

338 

98.3 

1896-1900 

1,703,638 

1,642 

96.4 

1901 

345,942 

371 

107.2 

1902 

348,199 

391 

112.3 

1903 

350,455 

388 

110.7 

1904 

352,709 

366 

103.8 

1905 

354,888 

424 

119.5 

1901-1905 

1,752,193 

1,940 

110.7 

1906 

357,065 

379 

106.1 

1907 

359,239 

471 

131.1 

1908 

361,410 

467 

129.2 

1909 

363,578 

456 

125.4" 

1910 

365,818 

502 
2,275 

137.2 

1906-1910 

1,807,110 

125.9 

1911 

368,056 

484 

131.5 

1912 

370,217 

567 

153.2 

1913 

372,299 

548 

147.2 

Source:     Annual    Reports   upon    the   Births,    Marriages, 
Divorces  and  Deaths  in  the  State  of  Maine. 


459 


APPENDIX  F  (PART  11) 

Table  7 

Mortality  from  Cancer  in  the  State  of  Massachusetts 

1856-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1856 

1,151,461 

217 

18.8 

1886 

1,998,174 

1,104 

55.3 

1857 

1,170,864 

242 

20.7 

1887 

2,055,821 

1,174 

57.1 

1858 

1,190,584 

289 

24.3 

1888 

2,115,131 

1,275 

60.3 

1859 

1,210,657 

306 

25.3 

1889 

2,176,153 

1,325 

60.9 

1860 

1,231,066 

535* 

27.2 
23.3 

1890 
1886-1890 

2,238,943 

1,387 

61.9 

1856-1860 

5,954,632 

1,389 

10,584,222 

6,265 

59.2 

1861 

1,238,177 

336 

27.1 

1891 

2,288,911 

1,395 

60.9 

1862 

1,245,328 

319 

25.6 

1892 

2,339,994 

1,402 

59.9 

1863 

1,252,521 

324 

25.9 

1893 

2,392,217 

1,533 

64.1 

1864 

1,259,756 

3^0 

26.2 

1894 

2,445,605 

1,568 

64.1 

1865 

1,267,031 

375 

29.6 
26.9 

1895 
1891-1895 

2,500,183 

1,749 

70.0 

1861-1865 

6,262,813 

1,684 

11,966,910 

7,647 

63.9 

1866 

1,302,992 

416 

31.9 

1896 

2,558,437 

1,798 

70.3 

1867 

1,339,976 

395 

29.5 

1897 

2,618,048 

1,739 

66.4 

1868 

1,378,010 

445 

32.3 

1898 

2,679,048 

1,907 

71.2 

1869 

1,417,125 

492 

34.7 

1899 

2,741,470 

1,838 

67.0 

1870 

1,457,351 

516 

35.4 
32.8 

1900 
1896-1900 

2,805,346 

1,998 

71.2 

1866-1870 

6,895,454 

2,264 

13,402,349 

9,280 

69.2 

1871 

1,494,337 

551 

36.9 

1901 

2,845,012 

2,080 

73.1 

1872 

1,532,260 

542 

35.4 

1902 

2,884,679 

2,141 

74.2 

1873 

1,571,142 

611 

38.9 

1903 

2,924,346 

2,243 

76.7 

1874 

1,611,016 

585 

36.3 

1904 

2,964,013 

2,351 

79.3 

1875 

1,651,912 

593 

35.9 
36.7 

1905 
1901-1905 

3,015,873 

2,501 

82.9 

1871-1875 

7,860,667 

2,882 

14,633,923 

11,316 

77.3 

1876 

1,677,351 

657 

39.2 

1906 

3,089,029 

2,603 

84.3 

1877 

1,703,182 

646 

37.9 

1907 

3,162,186 

2,744 

86.8 

1878 

1,729,412 

807 

46.7 

1908 

3,235,343 

2,814 

87.0 

1879 

1,756,043 

862 

49.1 

1909 

3,308,500 

2,871 

86.8 

1880 

1,783,085 

928 

52.0 
45.1 

1910 
1906-1910 

3,381,657 

3,028 

89.5 

1876-1880 

8,649,073 

3,900 

16,176,715 

14,060 

86.9 

1881 

1,813,818 

949 

52.3 

1911 

3,454,813 

3,199 

92.6 

1882 

1,845,086 

987 

53.5 

1912 

3,491,888 

3,282 

94.0 

1883 

1,876,895 

1,026 

54.7 

1913 

3,548,705 

3,526 

99.4 

1884 

1,909,810 

1,060 

55.5 

1885 

1,942,141 

1,087 

56.0 

Source: 

Annual     Reports     of 

Births, 

54.4 

Marriages  and  Deaths  in  Massa 
*Vital  Statistics  of  Massachusetts,  185 

chusetts. 

1881-1885 

9,387.750 

5,109 

6-1895. 

460 


APPENDIX  F  {PART  II) 

Table  8 

Mortality  from  Cancer  in  the  State  of  Massachusetts,  Males 

1856-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1856 

559,034 

72 

12.9 

1886 

961,921 

334 

34.7 

1857 

568,220 

78 

13.7 

1887 

991,934 

358 

36.1 

1858 

577,552 

98 

17.0 

1888 

1,022,877 

411 

40.2 

1859 

587,048 

99 

16.9 

1889 

1,054,781 

413 

39.2 

1890 

1,087,679 

414 

38.1 

1856-1859 

2,291,854 

347 

15.1 

1886-1890 

5,119,192 

1,930 

37.7 

1861 

597,792 

100 

16.7 

1862 

598,878 

103 

17.2 

1891 

1,111,953 

436 

39.2 

1863 

599,958 

107 

17.8 

1892 

1,136,769 

466 

41.0 

1864 

601,030 

112 

18.6 

1893 

1,162,139 

502 

43.2 

1865 

602,010 

124 

20.6 

1894 

1,188,075 

519 

43.7 

1895 

1,214,589 

535 

44.0 

1861-1865 

2,999,668 

546 

18.2 

1891-1895 

5,813,525 

2,458 

42.3 

1866 

621,006 

109 

17.6 

1867 

640,643 

136 

21.2 

1896 

1,243,656 

594 

47.8 

1868 

661,031 

146 

22.1 

1897 

1,273,419 

565 

44.4 

1869 

682,062 

146 

21.4 

1898 

1,303,893 

598 

45.9 

1870 

703,779 

184 

26.1 

1899 

1,335,370 

598 

44.8 

1900 

1,367,606 

684 

50.0 

1866-1870 

3,308,521 

721 

21.8 

1896-1900 

6,523,944 

3,039 

46.6 

1871 

721,615 

166 

23.0 

1872 

739,162 

182 

24.6 

1901 

1,386,659 

704 

50.8 

1873 

757,133 

198 

26.2 

1902 

1,405,416 

686 

48.8 

1874 

775,643 

190 

24.5 

1903 

1,424,157 

741 

52.0 

1875 

794,404 

173 

21.8 

1904 

1,442,882 

808 

56.0 

1905 

1,467,524 

843 

57.4 

1871-1875 

3,787,857 

909 

24.0 

1901-1905 

7,126,638 

3,782 

53.1 

1876 

806,974 

202 

25.0 

1877 

819,571 

176 

21.5 

1906 

1,506,519 

977 

64.9 

1878 

832,366 

260 

31.2 

1907 

1,545,360    ■ 

932 

60.3 

1879 

1908 

1,584,347 

966 

61.0 

1880 

858,565 

306 

35.6 

1909 

1,623,481 

991 

61.0 

1910 

1,662,761 

1,065 

64.1 

1876-1880 

3,317,466 

944 

28.5 

1906-1910 

7,922,468 

4,931 

62.2 

1881 

872,991 

338 

38.7 

1882 

887,671 

303 

34.1 

1911 

1,702,180 

1,177 

69.1 

1883 

902,599 

325 

36.0 

1912 

1,723,946 

1,115 

64.7 

1884 

917,855 

351 

38.2 

1913 

1,755,544 

1,282 

73.0 

1885 

932,810 

332 

35.6 

Source: 

Annual     Reports     of 

Births, 

1881-1885 

4,513,926 

1,649 

36.5 

Marriages  and  Deaths  in 

Massachusetts. 

461 


APPENDIX  F  {PART  II) 

Table  9 
Mortality  from  Cancer  in  the  State  of  Massachusetts,  Females 

1856-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1856 

592,427 

145 

24.5 

1886 

1,036,253 

770 

74.3 

1857 

602,644 

164 

27.2 

1887 

1,063,887 

816 

76.7 

1858 

613,032 

191 

31.2 

1888 

1,092,254 

864 

79.1 

1859 

623,609 

207 

33.2 

1889 

1,121,372 

912 

81.3 

1890 

1,151,264 

973 

84.5 

1856-1859 

2,431,712 

707 

29.1 

1886-1890 

5,465,030 

4,335 

79.3 

1861 

640,385 

236 

36.9 

1862 

646,450 

216 

33.4 

1891 

1,176,958 

959 

81.5 

1863 

652,563 

217 

33.3 

1892 

1,203,225 

936 

77.8 

1864 

658,726 

218 

33.1 

1893 

1,230,078 

1,031 

83.8 

1865 

665,021 

251 

37.7 

1894 

1,257,530 

1,049 

83.4 

1895 

1,285,594 

1,214 

94.4 

1861-1865 

3,263,145 

1,138 

34.9 

1891-1895 

6,153,385 

5,189 

84.3 

1866 

681,986 

307 

45.0 

1867 

699,333 

259 

37.0 

1896 

1,314,781 

1,204 

91.6 

1868 

716,979 

299 

41.7 

1897 

1,344,629 

1,174 

87.3 

1869 

735,063 

346 

47.1 

1898 

1,375,155 

1,309 

95.2 

1870 

753,572 

332 

44.1 

1899 

1,406,100 

1,240 

88.2 

1900 

1,437,740 

1,314 

91.4 

1866-1870 

3,586,933 

1,543 

43.0 

1896-1900 

6,878,405 

6,241 

90.7 

1871 

772,722 

385 

49.8 

1872 

793,098 

360 

45.4 

1901 

1,458,353 

1,376 

94.4 

1873 

814,009 

413 

50.7 

1902 

1,479,263 

1,455 

93.4 

1874 

835,473 

395 

47.3 

1903 

1,500,189 

1,502 

100.1 

1875 

857,508 

420 

49.0 

1904 

1,521,131 

1,543 

101.4 

1905 

1,548,349 

1,658 

107.1 

1871-1875 

4,072,810 

1,973 

48.4 

1901-1905 

7,507,285 

7,534 

100.4 

1876 

870,377 

455 

52.3 

1877 

883,611 

470 

53.2 

1906 

1,582,510 

1,626 

102.7 

1878 

897,04.6 

547 

61.0 

1907 

1,616,826 

1,812 

112.1 

1879 

1908 

1,650,996 

1,848 

111.9 

1880 

924,530 

622 

67.3 

1909 

1,685,019 

1,880 

111.6 

1910 

1,718,896 

1,963 

114.2 

1876-1880 

3,575,564 

2,094 

58.6 

1906-1910 

8,254,247 

9,129 

110.6 

1881 

940,827 

611 

64.9 

1882 

957,415 

684 

71.4 

1911 

1,752,627 

2,022 

115.4 

1883 

974,296 

701 

71.9 

1912 

1,767,942 

2,167 

122.6 

1884 

991,955 

709 

71.5 

1913 

1,793,161 

2,244 

125.1 

1885 

1,009,331 

755 

74.8 

fimirpp* 

AtitiuqI        ■Rf.r.nrta       nf 

Rlrtlna 

1881-1885 

4,873,824 

3,460 

71.0 

Marriages  and  Deaths 

in  Massachusetts. 

462 


APPENDIX  F  {PART  11) 


Table  10 

Table 

11 

Mortality  from  Cancer  in  the  State 

Mortality  from  Cancer  in  the  State 

of  New  Hampshire 

of  New  Hamps 

hire,  Males 

1884-1913 

Rate  per 

1887-1913 

Deaths 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1884 

358,806 

213 

59.4 

1887 

181,738 

70 

38.5 

1885 

361,760 

213 

58.9 

1888 

183,347 

66 

36.0 

1889 

184,957 

70 

37.8 

1886 

364,714 

206 

56.5 

1890 

186,571 

86 

46.1 

1887 

367,668 

218 

59.3 

1888 

370,622 

203 

54.8 

1887-1890 

736,613 

292 

39.6 

1889 

373,576 

213 

57.0 

1890 

376,530 

276 

73.3 

1891 

188,459 

74 

39.3 

1892 
1893 

190,351 
192,246 

69 
106 

36.2 
55.1 

1886-1890 

1,853,110 

1,116 

60.2 

1894 

194,143 

80 

41.2 

1891 

380,035 

222 

58.4 

1895 

196,044 

100 

51.0 

1892 

383,540 

235 

61.3 

1893 

387,046 

283 

73.1 

1891-1895 

961,243 

429 

44.6 

1894 

390,552 

230 

58.9 

1895 

394,058 

266 

67.5 

1896 

197,907 

84 

42.4 

1897 
1898 

199,773 
201,641 

87 
102 

43.5 
50.6 

1891-1895 

1,935,231 

1,236 

63.9 

1899 

203,510 

89 

43.7 

1896 

397,564 

275 

69.2 

1900 

205,382 

88 

42.8 

1897 

401,070 

265 

66.1 

1898 

404,576 

305 

75.4 

1896-1900 

1,008,213 

450 

44.6 

1899 

408,082 

279 

68.4 

1900 

411,588 

292 

70.9 

1901 

206,587 

114 

55.2 

1902 

207,713 

120 

57.8 

1896-1900 

2,022,880 

1,416 

70.0 

1903 

208,841 

110 

52.7 

1904 

209,928 

111 

52.9 

1901 

413,670 

364 

88.0 

1905 

211,016 

126 

59.7 

1902 

415,592 

341 

82.1 

1903 

417,514 

314 

75.2 

1901-1905 

1,044,085 

581 

55.6 

1904 

419,436 

326 

77.7 

1905 

421,358 

344 

81.6 

1906 

212,106 

109 

51.4 

1907 

213,197 

123 

57.7 

1901-1905 

2,087,570 

1,689 

80.9 

1908 

214,289 

126 

58.8 

1909 

215,383 

131 

60.8 

1906 

423,280 

354 

83.6 

1910 

216,477 

155 

71.6 

1907 

425,203 

386 

90.8 

1908 

427,126 

373 

87.3 

1906-1910 

1,071,452 

644 

60.1 

1909 

429,049 

383 

89.3 

1910 

430,972 

406 

94.2 

1911 

217,573 

138 

63.4 

1912 

218,670 

176 

80.5 

1906-1910 

2,135,630 

1,902 

89.1 

1913 

219,767 

164 

74.6 

1911 

432,894 

408 

94.2 

Source : 

Reports  relating  to 

the  Regis- 

1912 

434,818 

453 

104.2 

tration   and  Return  o1 

Births, 

Marriages, 

1913 

436,742 

453 

103.7 

Divorces  and  Deaths  i 

n  New  Hampshire. 

Source:  Reports  relating  to  the  Regis- 
tration and  Return  of  Births,  Marriages, 
Divorces  and  Deaths  in  New  Hampshire. 


463 


APPENDIX  V  {PART  II) 

Table  12 
Mortality  from  Cancer  in  the  State  of  New  Hampshire,  Females 

1887-1913 


Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Cancer 

Population 

1887 

185,930 

148 

79.6 

1888 

187,275 

137 

73.2 

1889 

188,619 

143 

75.8 

1890 

189,959 

190 

100.0 

1887-1890 

751,783 

618 

82.2 

1891 

191,576 

148 

77.3 

1892 

193,189 

166 

85.9 

1893 

194,800 

177 

90.9 

1894 

,  196,409 

150 

76.4 

1895 

198,014 

166 

83.8 

1891-1895 

973,988 

807 

82.9 

1896 

199,657 

191 

95.7 

1897 

201,297 

178 

88.4 

1898 

202,935 

203 

100.0 

1899 

204,572 

190 

92.9 

1900 

206,206 

204 

98.9 

1896-1900 

1.014,667 

966 

95.2 

1901 

207,083 

250 

120.7 

1902 

207,879 

221 

106.3 

1903 

208.673 

204 

97.8 

1904 

209,508 

215 

102.6 

1905 

210,342 

218 

103.6 

1901-1905 

1,043,485 

1,108 

106.2 

1906 

211,174 

245 

116.0 

1907 

212,006 

263 

124.1 

1908 

212,837 

247 

116.1 

1909 

213,666 

252 

117.9 

1910 

214,495 

251 

117.0 

1906-1910 

1,064,178 

1,258 

118.2 

1911 

215,321 

270 

125.4 

1912 

216,148 

277 

128.2 

1913 

216,975 

289 

133.2 

Source:  Reports  relating  to  the  Registration  and  Return 
of  Births,  Marriages,  Divorces  and  Deaths  in  New  Hamp- 
shire. 


464 


APPENDIX  F  (PART  11) 

Table  13 

Mortality  from  Cancer  in  the  State  of  New  Jersey 

1879-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1879 

1,109,009 

378 

34.1 

1901 

1,935,763 

1,042 

53.8 

1880 

1,131,116 

425 

37.6 

1902 

1,987,858 

1,031 

51.9 

1903 

2,039,953 

1,132 

55.5 

1881 

1,160,499 

451 

38.9 

1904 

2,092,048 

1,125 

53.8 

1882 
1883 

1,189,882 
1,219,265 

402 
461 

33.8 
37.8 

1905 

2,150,861 

1,282 

59.6 

1884 

1,248,649 

484 

38.8 

1901-1905 

10,206,483 

5,612 

55.0 

1885 

1,278,033 

498 

39.0 

1906 

2,231,481 
2,312,101 

1,389 
1,466 

62.2 

1881-1885 

6,096.328 

2,296 

37.7 

1907 

63!4 

1908 

2,392,721 

1,535 

64.2 

1886 

1,311,413 

546 

41.6 

1909 

2,473,342 

1,663 

67.2 

1887 
1888 

1,344,793 
1,378,173 

574 
612 

42.7 
44.4 

1910 

2,553,963 

1,838 

72.0 

1889 

1,411,553 

579 

41.0 

1906-1910 

11,963,608 

7,891 

66.0 

1890 

1,444,933 

640 

44.3 

1911 

2,634,583 
2,683,309 

1,942 
1,984 

73.7 

1886-1890 

6,890,865 

2,951 

42.8 

1912 

73.9 

1913 

2,749,486 

2,120 

77.1 

1891 

1,490,567 

642 

43.1 

1892 

1,536,201 

688 

44.8 

Source: 

Annual  Reports  of  the  Board 

1893 

1,581,836 

723 

45.7 

of  Health  of  the  State  of  New  Jersey. 

1894 

1,627,471 

731 

44.9 

1895 

1,673,106 

770 

46.0 
44.9 

1891-1895 

7,909,181 

3,554 

1896 

1,715,218 

811 

47.3 

1897 

1,757,330 

857 

48.8 

1898 

1,799,443 

852 

47.3 

1899 

1,841,556 

946 

51.4 

1900 

1,883,669 

921 

48.9 
48.8 

1896-1900 

8,997,216 

4,387 

465 


APPENDIX  F  {PART  II) 

Table  14 

Mortality  from  Cancer  in  the  State  of  New  York 

1885-1914 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1885 

6,543,021 

1,887 

34.0 

1906 

8,299,820 

6,169 

74.3 

1907 

8,514,447 

6,420 

75.4 

1886 

5,635,051 

2,050 

36.4 

1908 

8,729,074 

6,554 

75.1 

1887 

5,723,356 

2,363 

41.3 

1909 

8,943,701 

7,060 

78.9 

1888 

5,814,855 

2,497 

42.9 

1910 

9,158,328 

7,522 

82.1 

1889 

5,906,354 

2,638 

44.7 

1890 

5,997,853 

2,868 

47.8 

42.7 

1906-1910 
1911 

43,645,370 
9,372,954 

33,725 
7,970 

77.3 

1886-1890 

29,077,469 

12,416 

85.0 

1912 

9,526,146 

8,250 

86.6 

1891 

6,258,259 

3,028 

48.4 

1913 

9,712,954 

8,536 

87.9 

1892 

6,513,343 

3,152 

48.4 

1914 

9,838,328 

8,830 

89.8 

1893 

6,607,787 

3,232 

48.9 

1894 

6,702,230 

3,305 

49.3 

Source: 

Annual  Reports  of 

the  State 

1895 

6,796,674 

3,554 

52.3 
49.5 

Department  of  Health  of  New  ^ 

ifork. 

1891-1895 

32,878,293 

16,271 

1896 

6,891,118 

3,789 

55.0 

1897 

6,985,562 

4,131 

59.1 

1898 

7,080,006 

4,375 

61.8 

1899 

7,174,450 

4,535 

63.2 

1900 

7,268,894 

4,871 

67.0 
61.3 

1896-1900 

35,400,030 

21,701 

1901 

7,428,576 

5,033 

67.8 

1902 

7,588,259 

4,989 

65.7 

1903 

7,747,942 

5,456 

70.4 

1904 

7,907,625 

5,697 

72.0 

1905 

8,085,194 

6,055 

74.9 
70.3 

1901-1905 

38,757,596 

27,230 

406 


APPENDIX  F  (PART  II) 

Table  15 

Mortality  from  Cancer  in  the  State  of  Rhode  Island 

1871-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1871 

225,530 

66 

29.3 

1901 

438,861 

319 

72.7 

1872 

233,707 

95 

40.6 

1902 

449,166 

359 

79.9 

1873 

241,884 

■    106 

43.8 

1903 

459,471 

350 

76.2 

1874 

250,061 

87 

34.8 

1904 

469,776 

401 

85.4 

1875 

258,239 

95 

36.8 
37.1 

1905 
1901-1905 

481,150 

383 

79.6 

1871-1875 

1,209,421 

449 

2,298,424 

1,812 

78.8 

1876 

261,897 

106 

40.5 

1906 

493,976 

377 

76.3 

1877 

265,555 

135 

50.8 

1907 

506,802 

451 

89.0 

1878 

269,213 

119 

44.2 

1908 

519,628 

418 

80.4 

1879 

272,872 

125 

45.8 

1909 

532,455 

461 

86.6 

1880 

276,531 

125 

45.2 
45.3 

1910 
1906-1910 

545,282 

474 

86.9 

1876-1880 

1,346,068 

610 

2,598,143 

2,181 

83.9 

1881 

282,081 

145 

51.4 

1911 

558,108 

486 

87.1 

1882 

287,631 

132 

45.9 

1912 

568,114 

506 

89.1 

1883 

293,182 

169 

57.6 

1913 

579,665 

534 

92.1 

1884 

298,733 

156 

52.2 

1885 

304,284 

193 

63.4 

Source: 

Annual    Reports    relating    to 

Registry  and  Return  of  Births, 

Marriages, 

1881-1885 

1,465,911 

795 

54.2 

and  Deaths 

,  and  of  Divorce,  in  the  State  of 

Rhode  Island.      1912-1913,  United  States 

1886 

312,528 

162 

51.8 

Mortality  Statistics. 

1887 

320,772 

159 

49.6 

1888 

329,016 

193 

58.7 

1889 

337,261 

189 

56.0 

1890 

345,506 

165 

47.8 
52.8 

1886-1890 

1,645,083 

868 

1891 

353,356 

177 

50.1 

1892 

361,206 

181 

50.1 

1893 

369,056 

205 

55.5 

1894 

376,907 

216 

57.3 

1895 

384,758 

240 

62.4 
55.2 

1891-1895 

1,845,283 

1,019 

1896 

393,517 

238 

60.5 

1897 

402,276 

271 

67.4 

1898 

411,036 

293 

71.3 

1899 

419,796 

300 

71.5 

1900 

428,556 

303 

70.7 
68.4 

1896-1900 

2,055,181 

1,405 

467 


APPENDIX  F  (PART  II) 

Table  16 

Mortality  from  Cancer  in  the  State  of  Rhode  Island,  Males 

1871-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1871 

108,705 

25 

23.0 

1901 

215,876 

101 

46.8 

1872 

112,623 

26 

23.1 

1902 

221,259 

129 

58.3 

1873 

116,540 

45 

38.6 

1903 

226,657 

121 

63.4 

1874 

120,454 

23 

19.1 

1904 

232,069 

130 

66.0 

1875 

124,368 

24 

19.3 
24.5 

1905 
1901-1905 

238,025 

128 
609 

63.8 

1871-1875 

582,690 

143 

1,133,886 

53.7 

1876 

126,103 

27 

21.4 

1906 

244,716 

126 

61.6 

1877 

127,838 

29 

22.7 

1907 

251,424 

143 

66.9 

1878 

129,572 

38 

29.3 

1908 

258,151 

144 

55.8 

1879 

131,306 

39 

29.7 

1909 

264,896 

158 

69.6 

1880 

133,039 

45 

33.8 
27.5 

1910 
1906-1910 

271,659 

163 

60.0 

1876-1880 

647,858 

178 

1,290,846 

734 

66.9 

1881 

135,850 

40 

29.4 

1911 

■  278.440 

173 

62.1 

1882 

138,667 

40 

28.8 

1912 

283,830 

173 

61.0 

1883 

141,490 

51 

36.0 

1913 

289,671 

185 

63.9 

1884 

144,169 

39 

27.1 

1885 

147,152 

52 

35.3 

Source: 

Annual    Reports    relating    to 

Registry  and  Return  of  Births,  ] 

l/Tq  ■PT'I  a  (TPC 

VXcll  1  id^  ca. 

1881-1885 

707,328 

222 

31.4 

and  Deaths,  and  of  Divorce,  in  the  State  of 
Rhode  Island.     1912-1913,  United  States 

1886 

151,295 

42 

27.8 

Mortality 

Statistics. 

1887 

155,446 

49 

31.5 

1888 

159,639 

67 

42.0 

1889 

163,841 

65 

39.7 

1890 

168,020 

56 

33.3 
35.0 

1886-1890 

798,241 

279 

1891 

171,978 

48 

27.9 

1892 

175,980 

53 

30.1 

1893 

179,989 

54 

30.0 

1894 

184,006 

68 

37.0 

1895 

188,031 

77 

41.0 

1891-1895 

1896 
1897 
1898 
1899 
1900 

899,984 

192,509 
196,995 
201,490 
205,994 
210,507 

300 

69 
86 
88 
98 
102 

33.3 

35.8 
43.7 
43.7 
47.6 
48.5 

44.0 

1896-1900 

1,007,495 

443 

408 


APPENDIX  F  (PART  II) 

Table  17 
Mortality  from  Cancer  in  the  State  of  Rhode  Island,  Females 

1871-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1871 

116,825 

41 

35.1 

1901 

222,985 

218 

97.8 

1872 

121,084 

69 

57.0 

1902 

227,907 

230 

100.9 

1873 

125,344 

61 

48.7 

1903 

232,814 

229 

98.4 

1874 

129,607 

64 

49.4 

1904 

237,707 

271 

114.0 

1875 

133,871 

71 

53.0 
48.8 

1905 
1901-1905 

243,125 

255 

104.9 

1871-1875 

626,731 

306 

1,164,538 

1,203 

103.3 

1876 

135,794 

79 

58.2 

1906 

249,260 

251 

100.7 

1877 

137,717 

106 

77.0 

1907 

255,378 

308 

120.6 

1878 

139,641 

81 

58.0 

1908 

261,477 

274 

104.8 

1879 

141,566 

86 

60.7 

1909 

267,559 

303 

113.2 

1880 

143,492 

80 

55.8 
61.9 

1910 
1906-1910 

273,623 

311 

113.7 

1876-1880 

698,210 

432 

1,307,297 

1,447 

110.7 

1881 

146,231 

105 

71.8 

1911 

279,668 

313 

111.9 

1882 

148,964 

92 

61.8 

1912 

284,284 

333 

117.1 

1883 

151,692 

118 

77.8 

1913 

289,994 

349 

120.3 

1884 

154,564 

117 

75.7 

1885 

157,132 

141 

89.7 

Source: 

Annual    Reports    relating    to 

Registry  and  Return  of  Births, 

Marriages, 

1881-1885 

758,583 

573 

75.5 

and  Deaths 

,  and  of  Divorce,  in  the  State  of 

Rhode  Island.     1912-1913,  United  States 

1886 

161,233 

120 

74.4 

Mortality  Statistics. 

1887 

165,326 

110 

66.5 

1888 

169,377 

126 

74.4 

1889 

173,420 

124 

71.5 

1890 

177,486 

109 

61.4 
69.6 

1886-1890 

846,842 

589 

1891 

181,378 

129 

71.1 

1892 

185,226 

128 

69.1 

1893 

189,067 

151 

79.9 

1894 

192,901 

148 

76.7 

1895 

196,727 

163 
719 

82.9 
76.1 

1891-1895 

945,299 

1896 

201,008 

169 

84.1 

1897 

205,281 

185 

90.1 

1898 

209,546 

205 

97.8 

1899 

213,802 

202 

94.5 

1900 

218,049 

201 
962 

92.2 
91.8 

1896-1900 

1,047,686 

469 


APPENDIX  F  {PART  II) 

Table  18 

Mortality  from  Cancer  in  the  State  of  Vermont 

1871-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year             Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1871 

330,724 

149 

45.1 

1901            344,992 

242 

70.1 

1872 

330,897 

108 

32.6 

1902            346,239 

245 

70.8 

1873 

331,070 

117 

35.3 

1903            347,486 

313 

90.1 

1874 

331,243 

117 

35.3 

1904             348,733 

299 

85.7 

1875 

331,416 

125 

37.7 
37.2 

1905             349,980 

291 

83.1 

1871-1875 

1,655,350 

616 

1901-1905     1,737,430 

1,390 

80.0 

1876 

331,590 

174 

52.5 

1906            351,227 

287 

81.7 

1877 

331,764 

158 

47.6 

1907             352,474 

337 

95.6 

1878 

331,938 

177 

53.3 

1908            353,721 

319 

90.2 

1879 

332,112 

155 

46.7 

1909            354,968 

335 

94.4 

1880 

332,286 

177 

53.3 
50.7 

1910            356,216 

369 

103.6 

1876-1880 

1,659,690 

841 

1906-1910     1,768,606 

1,647 

93.1 

1881 

332,299 

147 

44.2 

1911             357,463 

347 

97.1 

1882 

332,312 

175 

52.7 

1912            358,710 

396 

110.4 

1883 

332,325 

187 

56.3 

1913            359,957 

378 

105.0 

1884 

332,338 

174 

52.4 

1885 

332,352 

192 

57.8 

Source:    Report  to 

the  Legislature  of 

Vermont  relating  to  the  Registry  and  Re- 

1881-1885 

1,661.626 

875 

52.7 

turns  of   Births,   Marriages,   Deaths  and 

Divorces  in  the  State. 

1886 

332,366 

188 

56.6 

1887 

332,380 

205 

61.7 

1888 

332,394 

188 

56.6 

1889 

332,408 

198 

59.6 

1890 

332,422 

191 

57.5 
58.4 

1886-1890 

1,661,970 

970 

1891 

333,543 

181 

54.3 

1892 

334,665 

178 

53.2 

1893 

335,787 

193 

57.5 

1894 

336,909 

192 

57.0 

1895 

338,031 

199 

58.9 
56.2 

1891-1895 

1,678,935 

943 

1896 

339,153 

200 

59.0 

1897 

340,275 

207 

60.8 

' 

1898 

341,397 

242 

70.9 

1899 

342,519 

270 

78.8 

1900 

343,641 

291 

84.7 
70.9 

1896-1900 

1,706,985 

1,210 

470 


APPENDIX  F  {PART  II) 

Table  19 

Mortality  from  Cancer  in  the  State  of  Vermont,  Males 

1871-1896 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1871 

165,792 

45 

27.1 

1886 

168,377 

80 

47.5 

1872 

165,912 

32 

19.3 

1887 

168,616 

67 

39.7 

1873 

166.032 

48 

28.9 

1888 

168,856 

78 

46.2 

1874 

166,151 

47 

28.3 

1889 

169,096 

68 

40.2 

1875 

166.271 

36 

21.7 
25.1 

1890 
1886-1890 

169,336 

77 

45.5 

1871-1875 

830,158 

208 

844,281 

370 

43.8 

1876 

166,392 

65 

'39.1 

1891 

169,940 

60 

35.3 

1877 

166,512 

62 

37.2 

1892 

170,545 

52 

30.5 

1878 

166,333 

65 

39.0 

1893 

171.151 

62 

36.2 

1879 

166,753 

66 

39.6 

1894 

171,723 

64 

37.3 

1880 

166.874 

68 

40.7 
39.1 

1895 
1891-1895 

172,294 

69 

40.0 

1876-1880 

833,164 

326 

855.653 

307 

35.9 

1881 

167,113 

50 

29.9 

1896 

172.866 

74 

42.8 

1882 

167,352 

58 

34.7 

1883 

167,591 

62 

37.0 

Source : 

Report  to 

the  Legislature   of 

1884 

167,831 

61 

36.3 

Vermont 

relating  to  the  Registry 

and  Re- 

1885 

168,104 

88 

52.3 

turns   of 

Births.    Marriages,    Deaths   and 

Divorces  in  the  State. 

1881-1885 

837,991 

319 

38.1 

Table  20 

Mortality  from  Cancer  in  the  State  of  Vermont,  Females 

1871-1896 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1871 

164.932 

104 

63.1 

1886 

163.989 

108 

65.9 

1872 

164,985 

76 

46.1 

1887 

163,764 

138 

84.3 

1873 

165,038 

69 

41.8 

1888 

163,538 

110 

67.3 

1874 

165,092 

70 

42.4 

1889 

163,312 

130 

79.6 

1875 

165,145 

89 

53.9 
49.4 

1890 
1886-1890 

163,086 

114 

69.9 

1871-1875 

825,192 

408 

817,689 

600 

73.4 

1876 

165,198 

109 

66.0 

1891 

163,603 

121 

74.0 

1877 

165,252 

96 

58.1 

1892 

164,120 

126 

76.8 

1878 

165,305 

112 

67.8 

1893 

164,636 

131 

79.6 

1879 

165,359 

89 

53.8 

1894 

165,186 

128 

77.5 

1880 

165,412 

109 

65.9 
62.3 

1895 
1891-1895 

165.737 

130 

78.4 

1876-1880 

826,526 

515 

823,282 

636 

77.3 

1881 

165,186 

97 

58.7 

1896 

166,287 

126 

75.8 

1882 

164,960 

117 

70.9 

1883 

164,734 

125 

75.9 

Source: 

Report  to 

the  Legislature   of 

1884 

164,507 

113 

68.7 

Vermont  relating  to  the  Registry 

and  Re- 

1885 

164,248 

104 

63.3 

turns   of   Births.    Marriages.    Deaths   and 

Divorces  in 

L  the  State. 

1881-1885 

823,635 

556 

67.5 

471 


APPENDIX  F  (PART  II) 

Table  21 
Mortality  from  Cancer  in  the  New  England  States 
New  York  and  New  Jersey 
1886-1913 


Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Cancer 

Population 

1886 

10,651,080 

4,536 

42.6 

1887 

10,853,980 

5,009 

46.1 

1888 

11,061,737 

5,316 

48.1 

1889 

11,271,207 

5,466 

48.5 

1890 

11,482,445 

5,888 

51.3 

1886-1890 

55,320,449 

26,215 

47.4 

1891 

11,867,145 

6,062 

51.1 

1892 

12,915,401 

6,606 

51.1 

1893 

13,139,735 

7,007 

53.3 

1894 

13,365,234 

7,132 

53.4 

1895 

13,591,924 

7,729 

56.9 

1891-1895 

64,879,439 

34,536 

53.2 

1896 

13,819,675 

8,088 

58.5 

1897 

14,048,783 

8,447 

60.1 

1898 

14,279,282 

9,022 

63.2 

1899 

14,511,204 

9,278 

63.9 

1900 

14,746,725 

9,810 

66.5 

1896-1900 

71,405,669 

44,645 

62.5 

1901 

15,037,650 

10,285 

68.4 

1902 

15,328,314 

10,345 

67.5 

1903 

16,618,979 

11,127 

71.2 

1904 

15,909,644 

11,479 

72.2 

1905 

16,238,175 

12,265 

75.5 

1901-1905 

78,132,762 

55,501 

71.0 

1906 

16,648,318 

12,605 

75.7 

1907 

17,058,464 

13,350 

78.3 

1908 

17,468,610 

13,514 

77.4 

1909 

17,878,759 

14,376 

80.4 

1910 

18,288,909 

15,295 

83.6 

1906-1910 

87,343,060 

69,140 

79.2 

1911 

18,699,051 

15,980 

85.5 

1912 

18,976,968 

16,640 

87.7 

1913 

19,327,238 

17,385 

90.0 

Note:  Maine 

!  not  included 

1886-1891. 

472 


APPENDIX  F  {PART  II) 

Table  22 

Mortality  from  Cancer  in  Twenty  Large  American  Cities 

1881-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year             Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

5,673,905 

2,812 

49.6 

1906        11,472,516 

8,713 

75.9 

1882 

5,869,498 

2,820 

48.0 

1907        11,747,948 

9,274 

78.9 

1883 

6,065,384 

2,847 

46.9 

1908        12,023,381 

9,355 

77.8 

1884 

6,261,552 

3,137 

50.1 

1909        12,298,814 

9,934 

80.8 

1885 

6,458,008 
30,328,347 

3,119 

48.3 
48.6 

1910        12,574,254 

10,425 

82.9 

1881-1885 

14,735 

1906-1910  60,116,913 

47,701 

79.3 

1886 

6,658,686 

3,209 

48.2 

1911        12,849,687 

10,713 

83.4 

1887 

6,859,665 

3,495 

51.0 

1912        13,125,121 

11,203 

85.4 

1888 

7,059,924 

3,512 

49.7 

1913        13,400,553 

11,971 

89.3 

1889 

7,261,499 

3,567 

49.1 

1890 

7,463,170 

4,101 

54.9 

Note:     Includes  Baltimore, 

Md.,   Bos- 

ton,  Mass.,  Brooklyn, 

IN .    1 .,  v^narieston. 

1886-1890  35,302,944 

17,884 

60.7 

S.  C.,  Chicago,  111.,  Cincinnati,  < 

3hio,  Day- 

ton,  Ohio,  Hartford,  C 

onn..  He 

boken.  N. 

1891 
1892 
1893 

7,702,582 
7,942,266 
8,182,229 

4,213 
4,371 
4,431 

54.7 
55.0 
54.2 

J.,  Jersey  City,  N.  J.,  NashWUe,  Tenn., 
Newark,  N.  J.,  New  Haven,  Conn.,  New 
Orleans,  La.,  New  York,  N.  Y..  Philadel- 

1894 
1895 

8,422,476 
8,662,957 

4,547 
4,951 

54.0 
57.2 

55.0 

phia,  Pa.,  Pro\-idence,  R.  I.,  Sava 
St.  Louis,  Mo.,  Washington,  D 

nnah,  Ga., 
C. 

1891-1895 

40,912,510 

22,513 

1896 

8,909,328 

5,178 

58.1 

1897 

9,155,967 

5,325 

58.2 

1898 

9,402,921 

5,649 

60.1 

1899 

9,650,196 

6,047 

62.7 

1900 

9,897,855 

6,334 

64.0 
60.7 

1896-1900  47.016,267 

28,533 

1901 

10,157,693 

6,771 

66.7 

1902 

10,417,536 

6,964 

66.8 

1903 

10,677,385 

7,399 

69.3 

1904 

10,937,234 

7,778 

71.1 

1905 

11,197,087 

8,215 

73.4 

1901-1905  53,386,935       37,127 


69.C 


473 


APPENDIX  F  {PART  II) 

Table  23 

Mortality  from  Cancer  in  Southern  Cities,  White 

1891-1914 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 
Cancer 

100,000 
Population 

Year 

Population 

from 
Cancer 

100,000 
Population 

1891 

891,023 

480 

53.9 

1906 

1.165,457 

887 

76.1 

1892 

907,130 

438 

48.3 

1907 

1,187,034 

956 

80.5 

1893 

923,238 

512 

55.5 

1908 

1,208,611 

976 

80.8 

1894 

939,347 

464 

49.4 

1909 

1,230,188 

979 

79.6 

1895 

955,456 

541 

56.6 
52.7 

1910 
1906-1910 

1,251,766 

1,107 

88.4 

1891-1895 

4,616,194 

2,435 

6.043,056 

4,905 

81.2 

1896 

971,566 

576 

59.3 

1911 

1,273,338 

1,071 

84.1 

1897 

987,678 

563 

57.0 

1912 

1,294,911 

1,159 

89.5 

1898 

1,003,791 

570 

56.8 

1913 

1,316,492 

1,272 

96.6 

1899 

1,019,904 

613 

60.1 

1914 

1,338,076 

1,248 

93.3 

1900 

1,036,017 

615 

59.4 

Note: 
ington. 

Tr"1"'l'^='    T«„U;^/^,-a     TiHr 

Wash- 

1896-1900 

5,018,956 

2,937 

58.5 

D. 

C,  New  Orleans,  La., 

Charles- 

ton,   S. 

C 

,   Memphis 

Tenn.,   Nashville, 

1901 

1,057,588 

664 

62.8 

Tenn.,  Richmond,  Va., 

Savannah 

Ga. 

1902 

1,079,160 

713 

66.1 

1903 

1,100,732 

753 

68.4 

1904 

1,122,305 

824 

73.4 

1905 

1,143,880 

846 

74.0 
69.0 

1901-1905 

5,503,665 

3,800 

Table  24 

Mortality  from  Cancer  in  Southern  Cities,  Colored 

1891-1914 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1891 

358,638 

144 

40.2 

1906 

448,736 

247 

55.0 

1892 

365,127 

129 

35.3 

1907 

454,016 

280 

61.7 

1893 

371,576 

143 

38.5 

1908 

459.296 

265 

67.7 

1894 

378,105 

143 

37.8 

1909 

464,576 

261 

66.2 

1895 

384,595 

167 

43.4 
39.1 

1910 
1906-1910 

469,857 

257 

64.7 

1891-1895 

1.858,041 

726 

2.296,481 

1,310 

57.0 

1896 

391,087 

141 

36.1 

1911 

475,138 

296 

62.3 

1897 

397,577 

152 

38.2 

1912 

480,419 

340 

70.8 

1898 

404,066 

165 

40.8 

1913 

485,699 

357 

73.5 

1899 

410,.557 

195 

47.5 

1914 

490,978 

368 

75.0 

1900 

417,048 

197 

47.2 

Note: 
ington,  D. 

[ncludes  Ba 
C,  New  Oi 

1896-1900 

2,020,335 

850 

42.1 

leans.  La.. 

Charles- 

ton.   S.   C 

.,   Memphis 

Tenn.,   Nashville, 

1901 

422,319 

217 

51.4 

Tenn.,  Richmond,  Va., 

Savannah 

Ga. 

1902 

427,610 

193 

45.1 

1903 

432,893 

206 

47.6 

1904 

438,175 

232 

52.9 

1905 

443,456 

239 

53.9 
50.2 

1901-1905 

2,164,453 

1,087 

474 


APPENDIX  F  {PART  II) 

Table  25 

Mortality  from  Cancer  in  Augusta,  Ga. 

1891-1913 


Year 

Deaths 

Rate  per 

Deaths 

Rate  per 

(Ending 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Nov.  30) 

Cancer 

Population 

Cancer 

Population 

1891 

33,914 

8 

23.6 

1906 

40,400 

19 

47.0 

1892 

34,528 

11 

31.9 

1907 

40,560 

13 

32.1 

1893 

35,142 

11 

31.3 

1908 

40,720 

24 

58.9 

1894 

35,756 

14 

39.2 

1909 

40,880 

20 

48.9 

1895 

36,370 

19 

52.2 
35.9 

1910 
1906-1910 

41,040 

•    24 

58.5 

1891-1895 

175,710 

63 

203,600 

100 

49.1 

1896 

36,984 

11 

29.7 

1911 

41,200 

33 

80.1 

1897 

37,598 

17 

45.2 

1912 

41,360 

23 

55.6 

1898 

38,212 

19 

49.7 

1913 

41,520 

32 

77.1 

1899 

38,826 

17 

43.8 

1900 

39,441 

16 

40.6 

Source: 

Annual  Reports  of  the  Board 

of  Health  ot  Augusta, 

bra. 

1896-1900 

191,061 

80 

41.9 

1901 

39,600 

17 

42.9 

1902 

39,760 

14 

35.2 

1903 

39,920 

19 

47.6 

1904 

40,080 

16 

39.9 

1905 

40,240 

24 

59.6 
45.1 

1901-1905 

199,600 

90 

Tab 

le26 

Mortality  from  Cancer 

in  Augusta 

,  Ga.,  Males 

1891- 

■1912 

Year 

Deaths 

Rate  per 

Deaths 

Rate  per 

(En.iinfj 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Nov.  30) 

Cancer 

Population 

Cancer 

Population 

1891 

15,606 

3 

19.2 

1906 

18,831 

6 

31.9 

1892 

15,897 

4 

25.2 

1907 

18,932 

1 

5.3 

1893 

16,188 

4 

24.7 

1908 

19,033 

6 

31.5 

1894 

16,479 

0 

1909 

19,135 

3 

15.7 

1895 

16,770 

2 

11.9 
16.1 

1910 
1906-1910 

19,237 

7 

36.4 

1891-1895 

80,940 

13 

95,168 

23 

24.2 

1896 

17,061 

1 

5.9 

1911 

19,339 

6 

31.0 

1897 

17,352 

3 

17.3 

1912 

19,441 

6 

30.9 

1898 

17,643 

8 

45.3 

1899 

17,934 

3 

16.7 

Source: 

Annual  Reports  of  the  Board 

1900 

18,225 
88,215 

2 

11.0 
19.3 

of  Health  of  Augusta, 

Ga. 

1896-1900 

17 

1901 

18,326 

4 

21.8 

1902 

18,427 

2 

10.9 

1903 

18,528 

3 

16.2 

4904 

18,629 

7 

37.6 

1905 

18,730 

9 

48.1 
27.0 

1901-1905 

92,640 

25 

475 


APPENDIX  F  (PART  II) 

Table  27 

Mortality  from  Cancer  in  Augusta,  Ga.,  Females 

1891-1912 


Year 

Deaths 

Rate  per 

(Ending 

Population 

from 

100,000 

Nov.  30) 

Cancer 

Population 

1891 

18,308 

5 

27.3 

1892 

18,631 

7 

37.6 

1893 

18,954 

7 

36.9 

1894 

19,277 

14 

72.6 

1895 

19,600 

17 

50 

86.7 

1891-1895 

94,770 

52.8 

1896 

19,923 

10 

50.2 

1897 

20,246 

14 

69.1 

1898 

20,569 

11 

53.5 

1899 

20,892 

14 

67.0 

1900 

21,216 

14 
63 

66.0 

1896-1900 

102,846 

61.3 

1901 

21,274 

13 

61.1 

1902 

21,333 

12 

56.3 

1903 

21,392 

16 

74.8 

1904 

21,451 

9 

42.0 

1905 

21,510 

15 

69.7 

1901-1905 

106,960 

65 

60.8 

1906 

21,569 

13 

60.3 

1907 

21,628 

12 

55.5 

1908 

21,687 

18 

83.0 

1909 

21,745 

17 

78.2 

1910 

21,803 

17 

77 

78.0 

1906-1910 

108,432 

71.0 

1911 

21,861 

27 

123.5 

1912 

21,919 

17 

77.6 

Source:    Annual    Reports    of    the    Board    of    Health    of 
Augusta,  Ga. 


476 


APPENDIX  F  {PART  II) 

Table  28 

Mortality  from  Cancer  in  Baltimore,  Md. 

1871-1914 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1871 

273,849 

53 

19.4 

1896 

479,149 

344 

71.8 

1872 

280,345 

48 

17.1 

1897 

486,601 

316 

64.9 

1873 

286,841 

78 

27.2 

1898 

494,053 

331 

67.0 

1874 

293,337 

92 

31.4 

1899 

501,505 

329 

65.6 

1875 

299,833 

127 

42.4 

27.8 

1900 
1896-1900 

508,957 

318 

62.5 

1871-1875 

1,434,205 

398 

2,470,265 

1,638 

66.3 

1876 

306,329 

126 

41.1 

1901 

513,909 

358 

69.7 

1877 

312,825 

149 

47.6 

1902 

518.861 

384 

74.0 

1878 

319,321 

149 

46.7 

1903 

523,814 

370 

70.6 

1879 

325,817 

152 

46.7 

1904 

528,767 

450 

85.1 

1880 

332,313 

168 

50.6 
46.6 

1905 
1901-1905 

533,720 

437 

81.9 

1876-1880 

1,596,605 

744 

2,619,071 

1,999 

76.3 

1881 

342,525 

175 

51.1 

1906 

538,673 

450 

83.5 

1882 

352,737 

164 

46.5 

1907 

543,626 

473 

87.0 

1883 

362,949 

164 

45.2 

1908 

548,579 

449 

81.8 

1884 

373,161 

183 

49.0 

1909 

553,532 

450 

81.3 

1885 

383,374 

185 

48.3 
48.0 

1910 
1906-1910 

558,485 

529 

94.7 

1881-1885 

1,814,746 

871 

2.742,895 

2,351 

85.8 

1886 

393,587 

207 

52.6 

1911 

563.438 

526 

93.4 

1887 

403,800 

230 

57.0 

1912 

568,391 

546 

96.1 

1888 

414,013 

225 

54.3' 

1913 

573,343 

602 

105.0 

1889 

424,226 

226 

53.3 

1914 

578,299 

518 

89.6 

1890 

434,439 

276 

63.5 

Source: 

Annual  Reports  of  th 

Y\n        n        »■ 

e  j-zeparL- 

1886-1890 

2,070,065 

1.164 

56.2 

ment  of  Public  Safety  of  the  City  of  Balti- 

more, Md. 

1891 

441,890 

267 

60.4 

1892 

449,341 

233 

51.9 

1893 

456,793 

251 

54.9 

1894 

464,245 

266 

57.3 

1895 

471,697 

302 

64.0 
57.8 

1891-1895 

2,283,966 

1,319 

477 


APPENDIX  F  {PART  II) 

Table  29 

Mortality  from  Cancer  in  Baltimore,  Md.,  White 

1891-1914 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1891 

373,350 

200 

53.6 

1906 

455,719 

341 

74.8 

1892 

379,557 

160 

42.2 

1907 

460,136 

347 

75.4 

1893 

385.764 

190 

49.3 

1908 

464,553 

355 

76.4 

1894 

391,971 

174 

44.4 

1909 

468,970 

351 

74.8 

1895 

398,178 

215 

54.0 

48.7 

1910 
1906-1910 

473,387 

420 

88.7 

1891-1895 

1,928,820 

939 

2,322,765 

1,814 

78.1 

1896 

404,386 

250 

61.8 

1911 

477,803 

410 

85.8 

1897 

410,594 

229 

55.8 

1912 

482.220 

425 

88.1 

1898 

416,802 

222 

53.3 

1913 

486,637 

514 

105.6 

1899 

423,010 

245 

57.9 

1914 

491,057 

438 

89.2 

1900 

429,218 

221 

51.5 

Source: 

Annual  Reports  of  the  Uepart- 

1896-1900 

2,084,010 

1,167 

56.0 

ment  of  Public  Safety  of  the  City  of  Balti- 

1901 

433,634 

270 

62.3 

more,  Md. 

1902 

438,051 

275 

62.8 

Note:  This  table  excludes  non- 

residents. 

1903 

442,468 

285 

64.4 

1904 

446,885 

331 

74.1 

1905 

451,302 

323 

71.6 
67.1 

1901-1905 

2,212,340 

1.484 

Table  36 
Mortality  from  Cancer  in  Baltimore,  Md. 
1891-1914 


Colored 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1891 

68,540 

24 

35.0 

1906 

82,954 

51 

61.6 

1892 

69,784 

23 

33.0 

1907 

83,490 

53 

63.6 

1893 

71.029 

17 

23.9 

1908 

84,026 

59 

70.2 

1894 

72,274 

22 

30.4 

1909 

84,562 

52 

61.6 

1895 

73.519 

31 

42.2 
32.9 

1910 
1906-1910 

85,098 

62 

61.1 

1891-1895 

355,146 

117 

420,130 

267 

63.6 

1896 

74,763 

26 

34.8 

•  1897 

76,007 

30 

39.5 

1911 

85,634 

55 

64.2 

1898 

77,251 

34 

44.0 

1912 

86,169 

69 

68.5 

1899 

78,495 

35 

44.6 

1913 

86,706 

88 

101.5 

1900 

79,739 

32 

40.1 
40.6 

1914 
Source: 

87,242              80 
Annual  Reports  of  tl 

91.7 

1896-1900 

386,255 

157 

le  Depart- 

ment  of  P 

Liblic  Safety 

of  the  City  of  Bal- 

4901 

80,275 

29 

36.1 

timore,  Md. 

1902 

80,810 

36 

44.5 

Note:  This  table  excludes  non 

-residents. 

1903 

81,346 

26 

32.0 

1904 

81,882 

44 

53.7 

1905 

82,418 

57 

69.2 

47.2 

1901-1905 

406,731 

192 

478 


APPENDIX  F  {PART  It) 

Table  31 

Mortality  from  Cancer  in  Baltimore,  Md.,  by  Organs  and  Parts 

1893-1902  Compared  with  1903-1912 


Deaths 
from 
Organ  or  Part  Cancer 

Buccal  cavity 142 

Stomach  and  liver 1,230 

Peritoneum, intestines  and  rectum.  .  199 

Female  generative  organs 710 

Breast 381 

Skin 78 

Other  or  not  specified  organs 459 


Allorgans 3,199 


Rate  per 

100,000 

Population 

2.9 
25.1 

4.1 
14.5 

7.8 

1.6 

9.3 

65.3 


Deaths 

from 

Cancer 

190 
1,890 
463 
806 
460 
137 
734 


Rate  per 

100,000 

Population 

3.5 
34.6 

8.5 
14.8 

8.4 

2.5 
13.4 


4,680        85.7 


Percentage 
of  Increase 

20.7 

37.8 

107.3 

2.1 

7.7 

56.3 

44.1 


31.2 


Source:     Annual  Reports  of  the  Health  Department  of  the  City  of  Baltimore,  Md. 


Table  32 

Mortality  from  Cancer  in  Boston,  Mass. 

1881-1914 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

368,349 

241 

65.4 

1901 

567,789 

455 

80.1 

1882 

373,860 

253 

67.7 

1902 

574,686 

482 

83.9 

1883 

379,371 

293 

77.2 

1903 

581,583 

511 

87.9 

1884 

384,882 

282 

73.3 

1904 

588,481 

565 

96.0 

1885 

390,393 

274 

70.2 
70.8 

1905 
1901-1905 

595,380 

628 

105.5 

1881-1885 

1,896,855 

1,343 

2,907,919 

2,641 

90.8 

1886 

402,009 

299 

74.4 

1906 

610,420 

580 

95.0 

1887 

413,626 

324 

78.3 

1907 

625,461 

611 

97.7 

1888 

425,243 

279 

65.6 

1908 

640,502 

628 

98.0 

1889 

436,860 

306 

70.0 

1909 

655,543 

670 

102.2 

1890 

448,477 

326 

72.7 
72.1 

1910 
1906-1910 

670,585 

693 

103.3 

1886-1890 

2,126,215 

1,534 

3,202,511 

3.182 

99.4 

1891 

458,165 

317 

69.2 

1911 

685,627 

769 

112.2 

1892 

467,853 

328 

70.1 

1912 

700,669 

785 

112.0 

1893 

477,542 

307 

64.3 

1913 

715,711 

841 

117.5 

1894 

487,231 

354 

72.7 

1914 

730,753 

876 

119.9 

1895 

496,920 

391 

78.7 

Source: 

Annual  Reports  of  the  Board 

1891-1895 

2,387.711 

1,697 

71.1 

of  Health 

of  the  City 

of  Boston 

,  Mass., 

Annual  Reports  of  the 

Registry 

Depart- 

1896 

609,714 

389 

76.3 

ment  of  the  City  of  Boston,  Mass. 

1897 

522,508 

400 

76.6 

1898 

535,302 

412 

77.0 

1899 

548,097 

402 

73.3 

1900 

560,892 

452 

80.6 
76.8 

1896-1900 

2,676,513 

2,055 

32 


479 


APPENDIX  F  {PART  II) 

Table  33 

Mortality  from  Cancer  in  Boston,  Mass.,  Males 

1881-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year            Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

175,371 

89 

50.7 

1906            298,187 

217 

72.8 

1882 

177,995 

72 

40.5 

1907             306,066 

219 

71.6 

1883 

180.616 

98 

54.3 

1908            313,945 

236 

75.2 

1884 

183,399 

94 

51.3 

1909            321,824 

259 

80.5 

1885 

186,182 

75 
428 

40.3 

47.4 

1910            329,703 

257 

77.9 

1881-1885 

903,563 

1906-1910     1,569,725 

1,188 

75.7 

1886 

192,496 

82 

42.6 

1911            337,582 

271 

80.3 

1887 

198,810 

87 

43.8 

1912             345,461 

270 

78.2 

1888 

205,124 

85 

41.4 

1913             353,340 

345 

97.6 

1889 

211,439 

90 

42.6 

1890 

217,754 

105 

48.2 

Source:     Annual  Reports  of  the  Board 

1886-1890 

1,025,623 

449 

43.8 

Annual   Reports  of  the 

Registry  Depart- 

ment  of  the  City  of  Boston,  Mass. 

1891 

222,136 

93 

41.9 

1892 

226,518 

99 

43.7 

1893 

230,900 

97 

42.0 

1894 

235,283 

116 

49.3 

1895 

239,666 

120 
525 

50.1 
45.5 

1891-1895 

1,154,503 

1896 

246,717 

137 

55.5 

1897 

253,768 

135 

53.2 

1898 

260,819 

122 

46.8 

1899 

267,870 

125 

46.7 

1900 

274,922 

168 
687 

61.1 

52.7 

' 

1896-1900 

1,304,096 

1901 

277,999 

147 

62.9 

1902 

281,076 

146 

51.9 

1903 

284,153 

188 

66.2 

1904 

287,231 

199 

69.3 

1905 

290,309 

226 
906 

77.8 
63.8 

1901-1905 

1,420,768 

480 


AFFEXDIX  F  (FART  II) 

Table  34 

Mortality  from  Cancer  in  Boston,  Mass.,  Females 

1881-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year             Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

192,978 

152 

78.8 

1906            312,233 

363 

116.3 

1882 

195,865 

181 

92.4 

1907             319,395 

392 

122.7 

1883 

198,755 

195 

98.1 

1908             326,557 

392 

120.0 

1884 

201,483 

188 

93.3 

1909             333,719 

411 

123.2 

1885 

204,211 

199 

97.4 
92.1 

1910            340,882 

436 

127.9 

1881-1885 

993,292 

915 

1906-1910     1,632,786 

1.994 

122.1 

1886 

209,513 

217 

103.6 

1911            348,045 

498 

143.1 

1887 

214,816 

237 

110.3 

1912             355,208 

515 

145.0 

1888 

220,119 

194 

88.1 

1913            362,371 

496 

136.9 

1889 

225,421 

216 

95.8 

1890 

230,723 

221 

95.8 

Source:     Annual  Reports  of  the  Board 

of  Health  of  the   City  of   Boston 
Annual  Reports  of    the  Registry 

,  Mass., 
Depart- 

1886-1890 

1,100,592 

1.085 

98.6 

ment  of  the  City  of  Bos 

ton,  Mass. 

1891 

236,029 

224 

94.9 

1892 

241,335 

229 

94.9 

1893 

246,642 

210 

85.1 

1894 

251,948 

238 

94.5 

1895 

257,254 

271 

105.3 
95.0 

1891-1895 

1,233.208 

1,172 

1896 

262,997 

252 

95.8 

1897 

268,740 

265 

98.6 

1898 

274,483 

290 

105.7 

1899 

280,227 

277 

98.8 

1900 

285,970 

284 

99.3 
99.7 

1896-1900 

1,372,417 

1,368 

1901 

289,790 

308 

106.3 

1902 

293,610 

336 

114.4 

1903 

297,430 

323 

108.6 

1904 

301,250 

366 

121.5 

/ 

1905 

305,071 

402 

131.8 
116.7 

1901-1905 

1,487,151 

1,735 

481 


APPENDIX  F  {PART  II) 

Table  35 

Mortality  from  Cancer  in  Boston,  Mass.,  by  Age  and  Sex 

1903-1912 


MALES 


Ages 

Under  20. 
20-29. . . . 
30-39.... 
40-49. . . . 
50-59.... 


60  and  over 1,121 


Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

50 

4.6 

51 

8.2 

137 

23.9 

362 

88.1 

621 

262.7 

1,121 

628.6 

Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

54 

4.9 

62 

9.3 

356 

61.6 

801 

198.1 

1,068 

428.1 

1,757 

745.5 

All  ages 2,342  75.2  4,098  126.5 

Source:     Annual  Reports  of  the  Registry  Department  of  the  City  of  Boston,  Mass. 


Table  36 

Mortality  from  Cancer  in  Boston,  Mass.,  by  Organs  and  Parts 

according  to  Sex,  1903-1912 


Organ  or  Part 


from 
Cancer 

Buccal  cavity 308 

Stomach  and  liver 2,027 

Peritoneum,  intestines,  rectum  1,127 

Female  generative  organs 921 

Breast 657 

Skin 82 

Other  or  not  specified  organs. .  1,318 


TOTAL 
Deaths       Rate  per 
100,000 
Population 

4.9 


31.9 
17.7 
14.5 
10.3 
1.3 
20.7 


MALES 

Deaths  Rate  per 

from  100,000 

Cancer  Population 

248  8.0 

918  29.5 

446  14.3 


7 

44 

679 


0.2 
1.4 

21.8 


FEMALES 
Deaths      Rate  per 
from         100,000 
Cancer    Population 


60 

1,109 

681 

921 

650 

38 


1.9 
34.2 
21.0 
28.4 
20.1 

1.2 
19.7 


All  organs 6,440         101.3         2,342  75.2         4,098         126.5 

Source:     Annual  Reports  of  the  Registry  Department  of  the  City  of  Boston,  Mass. 


482 


APPENDIX  F  {PART  II) 

Table  37 

Mortality  from  Cancer  in  Boston,  Mass.,  by  Organs  and  Parts 

according  to  Age,  Males,  1903-1912 

Number  of  Deaths 

60 

Organ  or  Part                             Under  20    20-29        30-39            40-49  50-59  and  over 

Buccal  cavity 1            1              3             39  75  129 

Stomach  and  liver 3           7           60           144  264  450 

Peritoneum,  intestines  and  rectum 11          13            33              70  113  206 

Breast ..                1  2  4 

Skin 5               6  6  27 

Other  or  not  specified  organs 35          30           46            102  161  305 

Morgans 50          51          137           362  621  1,121 

Rate  per  100,000  Population 

Buccalcavity 0.1         0.2           0.5             9.5  31.7  72.3 

Stomach  and  liver 0.3         1.1           8.7           35.1  111.7  252.3 

Peritoneum,  intestines  and  rectum ...  .   1.0        2.1           5.8           17.0  47.8  115.5 

Breast. ..             0.2  0.8  2.2 

Skin 0.9             1.5  2.5  15.1 

Other  or  not  specified  organs 3.2        4.8          8.0           24.8  68.2  171.2 

All  Organs 4.6         8.2        23.9           88.1  262.7  628.6 

Source :     Annual  Reports  of  the  Registry  Department  of  the  City  of  Boston,  Mass. 

Table  38 

Mortality  from  Cancer  in  Boston,  Mass.,  by  Organs  and  Parts 

according  to  Age,  Females,  1903-1912 

NoMBER  OF  Deaths 

60 

Organ  or  Part                              Under  20    20-29        30-39            40-49  50-59  and  over 

Buccal  cavity 4            1              4              10  13  28 

Stomach  and  liver 4            6            Q5            170  291  573 

Peritoneum,  intestines  and  rectum ...  .     13          15            38            115  157  343 

Generative  organs 1          19          124            235  293  249 

Breast 3           62            146  170  269 

Skin 1          ..              2               3  4  28 

Other  or  not  specified  organs 31          18           61            122  140  267 

All  organs 54          62          356           801  1,068  1,757 

Rate  per  100,000  Population 

Buccalcavity 0.4         0.2          0.7            2.5  5.2  11.9 

Stomach  and  liver 0.4         0.9         11.3          42.0  116.7  243.1 

Peritoneum,  intestines  and  rectum ...  .   1.2         2.3          Q.Q          28.4  62.9  145.5 

Generative  organs 0.1         2.9         21.5          58.1  117.5  105.7 

Breast 0.5         10.7          36.1  68.1  114.1 

Skin 0.1           ..            0.3             0.7  1.6  11.9 

Other  or  not  specified  organs 2.7         2.5         10.5           30.3  56.1  113.3 

Allorgans 4.9        9.3        61.6         198.1  428.1  745.5 

Source:     Annual  Reports  of  the  Registry  Department  of  the  City  of  Boston,  Mass. 


483 


APPENDIX  F  {PART  II) 

Table  39 

Mortality  from  Cancer  in  Brooklyn,  N.  Y. 

1871-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1871 

413,155 

155 

37.5 

1901 

1,213,358 

760 

62.6 

1872 

430,211 

147 

34.2 

1902 

1,260,135 

791 

62.8 

1873 

447,267 

170 

38.0 

1903 

1,306,912 

778 

59.5 

1874 

464,323 

197 

42.4 

1904 

1,353,688 

817 

60.4 

1875' 

481,379 

201 

41.8 
38.9 

1905 
1901-1905 

1,400,465 

899 

64.2 

1871-1875 

2.236,335 

870 

6,534,558 

4,045 

61.9 

1876 

498,435 

195 

39.1 

1906 

1,447,242 

975 

67.4 

1877 

515,492 

200 

38.8 

1907 

1,494,019 

993 

66.5 

1878 

532,549 

233 

43.8 

1908 

1,540,796 

1,016 

65.9 

1879 

549,606 

231 

42.0 

1909 

1,587,573 

1,110 

69.9 

1880 

566,663 

221 

39.0 

40.6 

1910 
1906-1910 

1,634,351 

1,212 

74.2 

1876-1880 

2,662,745 

1,080 

7,703,981 

5,306 

68.9 

1881 

590,631 

254 

43.0 

1911 

1,681,129 

1,221 

72.6 

1882 

614,599 

285 

46.4 

1912 

1,727,907 

1,252 

72.5 

1883 

638,567 

262 

41.0  > 

1913 

1,774,685 

1,346 

75.9 

1884 

662,535 

823 

48.8 

1885 

686,503 

301 

43.8 

Source: 

1871-1897, 

Annual  Reports  of 

the  Board  of  Health  of  the  City  oi 

Brooklyn 

1881-1885 

3,192,835 

1,425 

44.6 

N.  Y.,  1898-1912,  Annual  Reports  of  the 
Board  of  Health  of  the  City  of  New  York, 

1886 

710,471 

293 

41.2 

N.  Y.,  1913,  Report 

of  New  York  State 

1887 

734,439 

349 

47.5 

Department  of  Health 

1888 

758,407 

345 

45.5 

1889 

782,375 

320 

40.9 

1890 

806,343 

414 

61.3 

45.4 

1886-1890 

3.792,035 

1,721 

1891 

842,366 

416 

49.4 

1892 

878,390 

538 

61.2 

1893 

914,414 

441 

48.2 

1894 

950,438 

457 

48.1 

1895 

986,462 

572 

58.0 
63.0 

1891-1895 

4,572,070 

2,424 

1896 

1,022,486 

534 

62.2 

1897 

1,058,510 

561 

53.0 

1898 

1.094,534 

632 

67.7 

1899 

1,130,558 

701 

62.0 

1900 

1,166,582 

695 

69.6 
67.1 

1896-1900 

5,472,670 

3,123 

484 


APPENDIX  F  {PART  J  I) 

Table  40 

Mortality  from  Cancer  in  Brooklyn,  N.  Y.,  Males 

1872-1878  and  1903-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1872 

206,682 

31 

15.0 

1906 

715,367 

343 

47.9 

1873 

215,009 

50 

23.3 

1907 

738,973 

403 

54.5 

1874 

223,336 

64 

28.7 

1908 

762,579 

335 

43.9 

1875 

231,663 

63 

27.2 

1909 

786,185 

414 

52.7 

1876 

239,990 

60 

25.0 

1910 

809,791 

438 

54.1 

1877 
1878 

248,318 
256,646 

57 

72 

23.0 
28.1 

24.5 

1906-1910 
1911 

3,812,895 
833,397 

1,933 
479 

50.7 

1872-1878 

1,621,644 

397 

57.5 

1912 

857,003 

492 

57.4 

1903 

644,549 

293 

45.5 

1913 

880,609 

534 

60.6 

1904 
1905 

668,155 
691,761 

297 
313 

44.5 
45.2 

Source:     1872-1878,  Annual  Reports  of 
the  Board  of  Health  of  the  City  of  Brooklyn, 
N.  Y.,  1903-1913,  Annual  Reports  of  the 
Board  of  Health  of  the  City  of  New  York. 

N.Y. 

Table  41 
Mortality  from  Cancer  in  Brooklyn,  N,  Y. 
1872-1878  and  1903-1913 


Females 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1872 

223,529 

116 

51.9 

1906 

731,875 

632 

86.4 

1873 

232,258 

120 

51.7 

1907 

755,046 

590 

78.1 

1874 

240,987 

133 

55.2 

1908 

778,217 

681 

87.5 

1875 

249,716 

138 

55.3 

1909 

801,388 

696 

86.8 

1876 

258,445 

135 

52.2 

1910 

824,560 

774 

93.9 

1877 
1878 

267,174 
275,903 

143 
161 

53.5 
58.4 

54.1 

1906-1910 
1911 

3,891,086 

847,732 

3,373 

742 

86.7 

1872-1878 

1,748,012 

946 

87.5 

1912 

870,904 

760 

87.3 

1903 

662,363 

485 

73.2 

1913 

894,076 

812 

90.8 

1904 

685,533 

520 

75.9 

1905 

708,704 

586 

82.7 

Source: 

1872-1878, 

Annual 

Reports  of 

the  Board  of  Health  of  the  City  of  Brooklyn, 

N.  Y.,  1903-1913,  Annual  Reports  of  the 

Board  of  Health  of  the  City  of  New  York, 

N.  Y. 

485 


APPENDIX  F  (PART  II) 

Table  42 

Mortality  from  Cancer  in  Buffalo,  N.  Y. 

1886-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1886 

209,329 

78 

37.3 

1901 

357,227 

264 

73.9 

1887 

220,041 

102 

46.4 

1902 

362,067 

230 

63.5 

1888 

231,307 

110 

47.6 

1903 

366,907 

271 

73.9 

1889 

232,491 

104 

44.7 

1904 

371,747 

271 

72.9 

1890 

255,664 

132 

51.6 

45.8 

1905 
1901-1905 

376,587 

329 

87.4 

1886-1890 

1,148,832 

526 

1,834,535 

1,365 

74.4 

1891 

263,981 

119 

45.1 

1906 

386,012 

328 

85.0 

1892 

278,727 

114 

40.9 

1907 

395,437 

323 

81.7 

1893 

281,435 

138 

49.0 

1908 

404,863 

326 

80.5 

1894 

290,590 

156 

53.7 

1909 

414,289 

327 

78.9 

1895 

300,043 

133 

44.3 
46.7 

1910 
1906-1910 

423,715 

396 

93.5 

1891-1895 

1,414.776 

660 

2,024,316 

1,700 

84.0 

1896 

309,803 

166 

53.6  . 

1911 

433,141 

420 

97.0 

1897 

319,881 

188 

58.8 

1912 

442,567 

410 

92.6 

1898 

330,287 

214 

64.8 

1913 

451,993 

451 

99.8 

1899 

341,031 

207 

60.7 

1900 

352,387 

234 

66.4 

Source: 

Annual  Reports  of  the  Depart- 

ment  of  I 
N.Y. 

[paUVi    of    the 

City  of 

Buffalo 

1896-1900 

1,653,389 

1,009 

61.0 

Table  43 

Mortality  from  Cancer  in  Buffalo,  N.  Y.,  by  Sex 

1904-1905  and  1908-1913 


MALES 

FEMALES 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1904 
1905 

185,289 
187,879 

107 
141 

57.7 
75.0 

1904 
1905 

186,458 
188,708 

164 

188 

88.0 
99.6 

1908 
1909 
1910 

202,652 
207,577 
212,502 

146 
121 
155 

72.0 
58.3 

72.9 

1908 
1909 
1910 

202,211 
206,712 
211,213 

180 
206 
241 

89.0 

99.7 

114.1 

1911 
1912 
1913 

217,427 
222,352 

227,277 

170 
170 
189 

78.2 
76.5 
83.2 

1911 
1912 
1913 

215,714 
220,215 
224,716 

250 
240 
262 

115.9 
109.0 
116.6 

Source 
ment  of 

Annual  Reports  of  the  Depart- 
HeaUh  of  the  City  of  Buffalo, 

N.Y. 

486 


APPENDIX  F  (PART  II) 

Table  44 

Mortality  from  Cancer  in  Charleston,  S.  C. 

1881-1914 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1881 

50,481 

18 

35.7 

1906 

57,621 

24 

41.7 

1882 

50,978 

22 

43.2 

1907 

57,924 

40 

69.1 

1883 

51,475 

22 

42.7 

1908 

58,227 

24 

41.2 

1884 

51,972 

27 

52.0 

1909 

58,530 

32 

54.7 

1885 

52,469 

28 

53.4 
45.5 

1910 
1906-1910 

58,833 

36 

61.2 

1881-1885 

257,375 

117 

291,135 

156 

53.6 

1886 

52,966 

33 

62.3 

1911 

59,135 

46 

77.8 

1887 

53,463 

15 

28.1 

1912 

59,437 

35 

58.9 

1888 

53,960 

23 

42.6 

1913 

59,739 

41 

68.6 

1889 

54,457 

26 

47.7 

1914 

60,041 

34 

56.6 

1890 

54,955 

26 

47.3 

Source: 
Charleston 

Year    Books 
S.  C. 

of    the 

City    of 

1886-1890 

269,801 

123 

45.6 

1891 

55,040 

30 

54.5 

1892 

55,125 

26 

47.2 

1893 

55,210 

30 

54.3 

- 

1894 

55,295 

26 

47.0 

1895 

55,380 

34 

61.4 
52.9 

1891-1895 

276,050 

146 

1896 

55,465 

34 

61.3 

1897 

55,550 

26 

46.8 

1898 

55,635 

19 

34.2 

1899 

55,721 

54 

96.9 

1900 

55,807 

35 

62.7 
60.4 

1896-1900 

278,178 

168 

1901 

56,109 

33 

58.8 

1902 

56,411 

30 

53.2 

1903 

56,713 

29 

51.1 

1904 

57,015 

27 

47.4 

1905 

57,318 

30 

52.3 
52.5 

1901-1905 

283,566 

149 

487 


APPENDIX  F  {PART  II) 

Table  45 

Mortality  from  Cancer  in  Charleston,  S.  C,  White 

1881-1914 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

22,821 

11 

48.2 

1906 

26,352 

20 

75.9 

1882 

22,943 

12 

52.3 

1907 

26,705 

18 

67.4 

1883 

23,065 

9 

39.0 

1908 

27,058 

20 

73.9 

1884 

23,187 

11 

47.4 

1909 

27,411 

18 

65.7 

1885 

23,309 

13 

55.8 
48.6 

1910 
1906-1910 

27,764 

23 

82.8 

1881-1885 

115,325 

56 

135,290 

99 

73.2 

1886 

23,431 

18 

76.8 

1911 

28,116 

24 

85.4 

1887 

23,553 

6 

25.5 

1912 

28,468 

24 

84.3 

1888 

23,675 

15 

63.4 

1913 

28,820 

25 

86.7 

1889 

23,797 

18 

75.6 

1914 

29,172 

22 

75.4 

1890 

23,919 

14 

58.5 

Source: 
Charleston 

Year   Books 
S.  C. 

of    the 

City    of 

1886-1890 

118,375 

71 

60.0 

1891 

23,950 

16 

66.8 

1892 

23,982 

13 

54.2 

1893 

24,014 

16 

66.6 

1894 

24,046 

13 

54.1 

1895 

24,078 

15 

62.3 
60.8 

1891-1895 

120,070 

73 

1896 

24,110 

21 

87.1 

1897 

24,142 

15 

62.1 

1898 

24,174 

10 

41.4 

1899 

24,206 

34 

140.5 

1900 

24,238 

20 

82.5 
82.7 

1896-1900 

120,870 

100 

1901 

24,590 

18 

73.2 

1902 

24,942 

13 

52.1 

1903 

25,294 

17 

67.2 

1904 

25,646 

13 

50.7 

1905 

25,999 

18 

69.2 
62.5 

1901-1905 

126,471 

79 

488 


APPENDIX  F  {PART  II) 

Table  46 

Mortality  from  Cancer  in  Charleston,  S.  C,  Colored 

1881-1914 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

27,660 

7 

25.3 

1906 

31,269 

4 

12.8 

1882 

28,035 

10 

35.7 

1907 

31,219 

22 

70.5 

1883 

28,410 

13 

45.8 

1908 

31,169 

4 

12.8 

1884 

28,785 

16 

55.6 

1909 

31,119 

14 

45.0 

1885 

29,160 

15 

51.4 
42.9 

1910 
1906-1910 

31,069 

13 

41.8 

1881-1885 

142,050 

61 

155,845 

57 

36.6 

1886 

29,535 

15 

50.8 

1911 

31,019 

22 

70.9 

1887 

29,910 

9 

30.1 

1912 

30,969 

11 

35.5 

1888 

30,285 

8 

26.4 

1913 

30,919 

16 

51.7 

1889 

30,660 

8 

26.1 

1914 

30,869 

12 

38.9 

1890 

31,036 

12 

38.7 

Source: 

Year   Books 

of    the 

City    of 

1886-1890 

151,426 

52 

34.3 

Charleston, 

S.  C. 

1891 

31,090 

14 

45.0 

1892 

31,143 

13 

41.7 

1893 

31,196 

14 

44.9 

1894 

31,249 

13 

41.6 

1895 

31,302 

19 

60.7 
46.8 

1891-1895 

155,980 

73 

1896 

31,355 

13 

41.5 

1897 

31,408 

11 

35.0 

1898 

31,461 

9 

28.6 

1899 

31,515 

20 

63.5 

1900 

31,569 

15 

47.5 

43.2 

1896-1900 

157,308 

68 

1'901 

31,519 

15 

47.6 

1902 

31,469 

17 

54.0 

1903 

31,419 

12 

38.2 

1904 

31,369 

14 

44.6 

1905 

31,319 

12 

38.3 
44.6 

1901-1905 

157,095 

70 

489 


APPENDIX  F  {PART  II) 

Table  47 

Mortality  from  Cancer  in  Chicago,  111. 

1871-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1871 

319,397 

68 

21.3 

1901 

1,747,245 

1,097 

62.8 

1872 

339,817 

75 

22.1 

1902 

1,795,915 

1,169 

65.1 

1873 

360,238 

107 

29.7 

1903 

1,844,586 

1,172 

63.5 

1874 

380,659 

110 

28.9 

1904 

1,893,257 

1,203 

63.5 

1875 

401,080 

123 

30.7 
26.8 

1905 
1901-1905 

1,941,928 

1,280 

65.9 

1871-1875 

1,801,191 

483 

9,222,931 

5,921 

64.2 

1876 

421,501 

122 

28.9 

1906 

1,990,599 

1,430 

71.8 

1877 

441,922 

130 

29.4 

1907 

2,039,270 

1,538 

75.4 

1878 

462,343 

177 

38.3 

1908 

2,087,941 

1,571 

75.2 

1879 

482,764 

177 

36.7 

1909 

2,136,612 

1,646 

77.0 

1880 

503,185 

163 

32.4 
33.3 

1910 
1906-1910 

2,185,283 

1,804 

82.6 

1876-1880 

2,311,715 

769 

10,439,705 

7,989 

76.5 

1881 

562,851 

217 

38.6 

1911 

2,233,953 

1,799 

80.5 

1882 

622,517 

220 

35.3 

1912 

2,282,623 

1,798 

78.8 

1883 

682,183 

232 

34.0 

1913 

2,331,293 

2,004 

86.0 

1884 

741,849 

265 

35.7 

1885 

801,515 

249 

31.1 

Source: 

Annual  Reports  of  th 

3  Depart- 

ment  of  Health  of  Chicago,  111.     1910-1913, 

1881-1885 

3,410,915 

1,183 

34.7 

United  States  Mortality 

Statistics. 

1886 

861,182 

230 

26.7 

1887 

920,849 

301 

32.7 

1888 

980,516 

361 

36.8 

1889 

1,040,183 

379 

36.4 

1890 

1,099,850 

461 

41.9 
35.3 

1886-1890 

4,902,580 

1,732 

1891 

1,159,722 

546 

47.1 

1892 

1,219,594 

546 

44.8 

1893 

1,279,466 

617 

48.2 

1894 

1,339,338 

640 

47.8 

1895 

1,399,210 

682 

48.7 
47.4 

1891-1895 

6,397,330 

3,031 

1896 

1,459,083 

734 

50.3 

1897 

1,518,956 

773 

50.9 

1898 

1,578,829 

893 

56.6 

1899 

1^638,702 

985 

60.1 

1900 

1,698,575 

986 

58.0 
55.4 

1896-1900 

7,894,145 

4,371 

490 


APPENDIX  F  (PART  IP) 

Table  48 
Mortality  from  Cancer  in  Chicago,  III. 
1895-1913 


Males 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1895 

715,903 

288 

40.2 

1906 

1,020,820 

660 

64.7 

1907 

1,047,056 

663 

63.3 

1896 

745,404 

335 

44.9 

1908 

1,073,292 

685 

63.8 

1897 

774,905 

323 

41.7 

1909 

1,099,528 

726 

66.0 

1898 

804,406 

369 

45.9 

1910 

1,125,764 

768 

68.2 

1899 

833,907 

428 

51.3 

1900 

863,408 

423 

49.0 
46.7 

1906-1910 
1911 

5,366,460 
1,152,000 

3,502 

757 

65.3 

1896-1900 

4,022,030 

1.878 

65.7 

1912 

1,178,236 

777 

65.9 

WOl 

889,643 

463 

52.0 

1913 

1,204,472 

851 

70.7 

1902 

915,878 

482 

52.6 

1903 

942,113 

542 

57.5 

Source: 

Annual  Reports  of  the  Depart- 

1904 

968,348 

504 

52.0 

ment  of  Health  of  Chicago,  111. 

1910-1913, 

1905 

994,584 

576 

57.9 
54.5 

United  States  Mortality 

Statist 

ics. 

1901-1905 

4,710,566 

2,567 

Table  49 
Mortality  from  Cancer  in  Chicago,  111. 
1895-1913 


Females 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1895 

683,307 

394 

57.7 

1906 

969,779 

770 

79.4 

1907 

992,214 

875 

88.2 

1896 

713,679 

399 

55.9 

1908 

1,014,649 

886 

87.3 

1897 

744,051 

450 

60.5 

1909 

1,037,084 

920 

88.7 

1898 

774,423 

524 

67.7 

1910 

1,059,519 

1,036 

97.8 

1899 

804,795 

557 

69.2 

1900 

835,167 

663 

67.4 
64.4 

1906-1910 
1911 

5,073,245 
1,081,953 

4,487 
1,042 

88.4 

1896-1900 

3,872,115 

2,493 

96.3 

1912 

1,104,387 

1,021 

92.4 

1901 

857,602 

634 

73.9 

1913 

1,126,821 

1,153 

102.3 

1902 

880,037 

687 

78.1 

1903 

902,473 

630 

69.8 

Source : 

Annual  Reports  of  the  Depart- 

1904 

924,909 

699 

75.6 

ment  of  Health  of  Chicag 

3.  111. 

1910-1913, 

1905 

947,344 

704 

74.3 
74.3 

United  States  Mortality 

Statist 

,1CS. 

1901-1905 

4,512,365 

3,354 

491 


APPENDIX  F  {PART  II) 

Table  50 

Mortality  from  Cancer  in  Chicago,  111.,  by  Organs  and  Parts 

according  to  Sex,  1903-1912 


Organ  or  Part 

Buccal  cavity 

Stomach  and  liver 

Peritoneum,  intestines,  rectum 

Female  generative  organs 

Breast 

Skin 

Other  or  not  specified  organs. . . 


Deaths 

from 

Cancer 

388 
6,542 
1,611 
2,440 
1,128 

212 
2,920 


TOTAL 
Rate  per 
100,000 
Population 

1.9 
31.7 

7.8 
11.8 

5.5 

1.0 
14.2 


MALES 

Deaths  Rate  per 

from  100,000 

Cancer  Population 

334  3.2 

3,617  34.1 

725  6.8 


5 

122 
1,855 


0.0 

1.2 

17.5 


FEMALES 

Deaths        Rate  per 


from 
Cancer 

54 

2,925 

886 

2,440 

1,123 

90 
1,065 


100,000 
Population 

0.5 


24.3 

11.2 

0.9 

10.6 


AUorgans 15,241  73.9  6,658  62.8         8,583  85.5 

Source:     Annual  Reports  of  the  Department  of  Health  of  the  City  of  Chicago,  111. 

Table  51 

Mortality  from  Cancer  in  Cincinnati,  Ohio 

1871-1913 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1871 

220,129 

49 

22.3 

1896 

314,302 

209 

66.5 

1872 

224,019 

66 

29.5 

1897 

317,202 

189 

59.6 

1873 

227,909 

61 

26.8 

1898 

320,102 

195 

60.9 

1874 

231,799 

66 

28.5 

1899 

323,002 

205 

63.5 

1875 

235,689 

79 

33.5 

28.2 

1900 
1896-1900 

325,902 

198 

60.8 

1871-1875 

1,139,545 

321 

1,600,510 

996 

62.2 

1876 

239,579 

76 

31.7 

1901 

329,670 

223 

67.6 

1877 

243,469 

80 

32.9 

1902 

333,439 

227 

68.1 

1878 

247,359 

66 

26.7 

1903 

337,208 

267 

79.2 

1879 

251,249 

88 

35.0 

1904 

340,977 

250 

73.3 

1880 

255,139 

105 

41.2 
33.6 

1905 
1901-1905 

344,746 

228 

66.1 

1876-1880 

1,236,795 

415 

1,686,040 

1.195 

70.9 

1881 

259,315 

103 

39.7 

1906 

348,515 

376 

107.9 

1882 

263,492 

111 

42.1 

1907 

352,284 

305 

86.6 

1883 

267,669 

115 

43.0 

1908 

356,053 

328 

92.1 

1884 

271,846 

98 

36.1 

1909 

359,822 

344 

95.6 

1885 

276,023 

93 

33.7 
38.9 

1910 
1906-1910 

363,591 

302 

83.1 

1881-1885 

1,338,345 

520 

1,780,265 

1,655 

93,0 

1886 
1887 
1888 
1889 

280,200 
284,377 
288,554 
292,731 

124 
137 
154 
124 

44.3 
48.2 
53.4 
42.4 

1911 
1912 
1913 

367,360 
371,129 

374,898 

354 
352 
394 

96.4 

94.8 

105.1 

1890 

296,908 

129 

43.4 

Source: 

Annual  Reports  of  the  Board 

1886-1890 

1,442,770 

608 

46.3 

of  Health  ot  the  Uity  ot  l^mcinnati,  Uliio. 

1891 

299,807 

159 

53.0 

1892 

302,706 

148 

48.9 

1893 

305,605 

160 

52.4 

1894 

308,504 

184 

59.6 

1895 

311,403 

152 

48.8 
52.6 

1891-1895 

1,528,025 

803 

492 


APPENDIX  F  {PART  II) 


Table  52 

Table  53 

Mortality  from  Cancer  in  Cincinnati 

Mortality  from  Cancer  in  Cincinnati 

Ohio,  Males 

Ohio,  Females 

1891-191 

13 

Deaths 

Rate  per 

1891-1913 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1891 

146,223 

53 

36.2 

1891 

153,584 

106 

69.0 

1892 

147,436 

61 

41.4 

1892 

155,270 

87 

56.0 

1893 

148;649 

60 

40.4 

1893 

156,956 

100 

63.7 

1894 

149,862 

77 

51.4 

1894 

158,642 

107 

67.4 

1895 

151,075 

49 

32.4 
40.4 

1895 
1891-1895 

160,328 

103 

64.2 

1891-1895 

743,245 

300 

784,780 

503 

64.1 

1896 

152,288 

75 

49.2 

1896 

162,014 

134 

82.7 

1897 

153,501 

74 

48.2 

1897 

163,701 

115 

70.3 

1898 

154,714 

88 

56.9 

1898 

165,388 

107 

64.7 

1899 

155,927 

84 

53.9 

1899 

167,075 

121 

72.4 

1900 

157.140 

83 

52.8 
52.2 

1900 
1896-1900 

168,762 

115 

68.1 

1896-1900 

773,570 

404 

826,940 

592 

71.6 

1901 

159,177 

77 

48.4 

1901 

170,493 

146 

85.6 

1902 

161,214 

77 

47.8 

1902 

172,225 

150 

87.1 

1903 

163,251 

97 

59.4 

1903 

173,957 

170 

97.7 

1904 

165,288 

88 

53.2 

1904 

175,689 

162 

92.2 

1905 

167,325 

83 

49.6 
51.7 

1905 
1901-1905 

177,421 

145 

81.7 

1901-1905 

816,255 

422 

869,785 

773 

88.9 

1906 

169,362 

108 

63.8 

1906 

179,153 

268 

149.6 

1907 

171,399 

101 

58.9 

1907 

180,885 

204 

112.8 

1908 

173,436 

129 

74.4 

1908 

182,617 

199 

109.0 

1909 

175,473 

125 

71.2 

1909 

184,349 

219 

118.8 

1910 

177,511 

126 

71.0 
67.9 

1910 
1906-1910 

186,080 

176 

94.6 

1906-1910 

867,181 

589 

913.084 

1.066 

116.7 

1911 

179,549 

130 

72.4 

1911 

187,811 

224 

119.3 

1912 

181,587 

134 

73.8 

1912 

189,542 

218 

115.0 

1913 

183,625 

141 

76.8 

1913 

191,273 

253 

132.3 

Source: 

Annual  Reports  of  the  Board 

Source: 

Annual  Reports  of  the  Board 

of  Health  of  the  City  of 

Cincinnati,  Ohio. 

of  Health  of  the  City 

of  Cincinnati,  Ohio. 

APPENDIX  F  {PART  II) 

Table  54 

Mortality  from  Cancer  in  Cleveland,  Ohio 

1884-1913 


Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Cancer 

Population 

1884 

200,627 

78 

38.9 

1885 

210,748 

73 

34.6 

1886 

220,869 

76 

34.4 

1887 

230,990 

100 

43.3 

1888 

241,111 

100 

41.5 

1889 

251,232 

102 

40.6 

1890 

261,353 

111 

42.5 

1886-1890 

1,205,555 

489 

40.6 

1891 

273,394 

111 

40.6 

1892 

285,435 

102 

35.7 

1893 

297,476 

150 

50.4 

1894 

309,517 

138 

44.6 

1895 

321,558 

192 

59.7 

1891-1895 

1,487,380 

693 

46.6 

1896 

333,600 

165 

49.5 

1897 

345,642 

183 

52.9 

1898 

357,684 

171 

47.8 

1899 

369,726 

184 

49.8 

1900 

381,768 

187 

49.0 

1896-1900 

1,788,420 

890 

49.8 

1901 

399,657 

211 

52.8 

1902 

417,546 

196 

46.9 

1903 

435,435 

228 

52.4 

1904 

453,324 

233 

51.4 

1905 

471,213 

269 

57.1 

1901-1905 

2,177,175 

1,137 

52.2 

1906 

489,103 

290 

59.3 

1907 

506,993 

295 

58.2 

1908 

524,883 

328 

62.5 

1909 

542,773 

333 

61.4 

1910 

560,663 

405 

72.2 

1906-1910 

2,624,415 

1,651 

62.9 

1911 

578,553 

422 

72.9 

1912 

596,443 

472 

79.1 

1913 

614,333 

489 

79.6 

Source:     Annual   Reports   of   the  Public  Health  Depart- 
ment of  the  City  of  Cleveland,  Ohio. 


494 


APPENDIX  F  {PART  II) 


Table  55 

Table  56 

Mortalit 

y  from  Cancer  in 
Ohio,  Males 

Cleveland 

Mortality  from  Cancer  in 
Ohio,  Females 

Cleveland 

1885- 

1913 

Rate  per 

100,000 

Population 

Year 

1885- 

1913 

Year 

Population 

Deaths 
from 
Cancer 

Population 

Deaths 

from 

Cancer 

Rate  per 

100,000 

Population 

1885 

107,121 

30 

28.0 

1885 

103,627 

43 

41.5 

1886 

112,210 

39 

34.8 

1886 

108,659 

37 

34.1 

1887 
1888 
1889 
1890 


122,373 
127,447 
132,517 


36 

42 
44 


1886-1890   494,547 


1891 
1892 
1893 
1894 
1895 


138,527 
144,537 
150,546 
156,556 
162,566 


161 

40 
40 
56 
5Q 


29.4 
33.0 
33.2 

32.6 

28.9 
27.7 
37.2 
35.8 
50.4 


1887 
1888 
1889 
1890 


118,738 
123,785 
128,836 


1886-1890   480,018 


1891 
1892 
1893 
1894 
1895 


134,867 
140,898 
146,930 
152,961 
158,992 


64 
60 
67 


71 
62 


110 


53.9 
48.5 
52.0 

47.5 

52.6 
44.0 
64.0 
53.6 
69.2 


1891-1895 

752,732 

274 

36.4 

1891-1895 

734,648 

419 

57.0 

1896 

168,576 

80 

47.5 

1896 

165,024 

85 

51.5 

1897 

174,586 

67 

38.4 

1897 

171,056 

116 

67.8 

1898 

180,596 

76 

42.1 

1898 

177,088 

95 

53.6 

1899 

186,606 

85 

45.6 

1899 

183,120 

99 

54.1 

1900 

192,616 

81 

42.1 
43.1 

1900 

1896-1900 

189,152 

106 

56.0 

1896-1900 

902.980 

389 

885,440 

501 

56.6 

1901 

202,280 

76 

37.6 

1901 

197,377 

135 

68.4 

1902 

211,944 

86 

40.6 

1902 

205,602 

110 

53.5 

1903 

221,608 

91 

41.1 

1903 

213,827 

137 

64.1 

1904 

231,272 

106 

45.8 

1904 

222,052 

127 

57.2 

1905 

240,937 

120 

49.8 
43.2 

1905 
1901-1905 

230,276 

149 

64.7 

1901-1905 

1,108,041 

479 

1,069,134 

658 

61.5 

1906 

250,602 

111 

44.3 

1906 

238,501 

179 

75.1 

1907 

260,267 

114 

43.8 

1907 

246,726 

181 

73.4 

1908 

269,932 

141 

52.2 

1908 

254,951 

187 

73.3 

1909 

279,597 

135 

48.3 

1909 

263,176 

198 

75.2 

1910 

289,262 

160 

55.3 
49.0 

1910 
1906-1910 

271,401 

245 

90.3 

1906-1910 

1,349,660 

661 

1,274,755 

990 

77.7 

1911 

298,927 

173 

57.9 

1911 

279,626 

249 

89.0 

1912 

308,592 

204 

66.1 

1912 

287,851 

268 

93.1 

1913 

318,257 

227 

71.3 

1913 

296,076 

262 

88.5 

Source: 

Annual  Report 

s  of  the 

Public 

Source: 

Annual  Reports  of  the  Public 

Health  Department  of  the 

City  of 

Cleve- 

Health  Department  of 

the  City  of  Cleve- 

land,  Ohio. 

land,  Ohio. 

495 


APPENDIX  F  (PART  II) 

Table  57 

Mortality  from  Cancer  in  Cleveland,  Ohio,  by  Organs  and  Parts 

according  to  Sex,  1903-1912 


TOTAL 

MALES 

FEMALES 

Deaths 

Rate  per 

Deaths 

Rate  per 

Deaths 

Rate  per 

Organ  or  Part 

from 

100,000 

from 

100,000 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

Cancer 

Population 

Buccal  cavity 

47 

0.9 

36 

1.4 

11 

0.4 

Stomach  and  liver 

1,299 

278 

25.2 
5.4 

664 
105 

25.0 
4.0 

635 
173 

25.3 

Peritoneum,  intestines,  rectum 

6.9 

Female  generative  organs 

408 

7.9 

6 

0.2 

402 

16.0 

Breast 

173 

3.4 

5 

0.2 

168 

6.7 

Skin 

63 

1.2 

38 

1.4 

25 

1.0 

Other  or  not  specified  organs. . . 

1,007 
3,275 

19.5 
63.5 

501 

18.9 
51.1 

506 

20.2 

All  organs 

1.355 

1,920 

76.5 

Source :     Annual  Reports  of  the  Public  Health  Department  of  the  City  of  Cleveland, 
Ohio. 

Table  58 

Mortality  from  Cancer  in  Columbus,  Ohio 

1900-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1900 

125,560 

85 

67.7 

1906 

159,130 

101 

63.5 

1907 

164,725 

102 

61.9 

1901 

131,155 

66 

50.3 

1908 

170,320 

135 

79.3 

1902 

136,750 

86 

62.9 

1909 

175,915 

173 

98.3 

1903 

142,345 

91 

63.9 

1910 

181,511 

166 

91.5 

1904 

147,940 

101 

68.3 

1905 

153,535 

104 

67.7 
62.9 

1906-1910 
1911 

851,601 
187,106 

677 
163 

79.5 

1901-1905 

711,725 

448 

87.1 

1912 

192,701 

186 

96.5 

1913 

198,296 

181 

91.3 

Source: 

United  States  Mortality  Sta- 

tistics. 

496 


APPENDIX  F  {PART  II) 

Table  59 

Mortality  from  Cancer  in  Dayton,  Ohio 

1871-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer       Population 

1871 

31,293 

11 

35.2 

1896 

75,686 

46 

60.8 

1872 

32.113 

11 

34.3 

1897 

78,097 

54 

69.1 

1873 

32,933 

12 

36.4 

1898 

80,509 

43 

53.4 

1874 

33,753 

9 

26.7 

1899 

82,921 

.      55 

66.3 

1875 

34,573 

9 

26.0 
31.6 

1900 
1896-1900 

85,333 

56 

65.6 

1871-1875 

164,665 

52 

402,546 

254 

63.1 

1876 

35,394 

17 

48.0 

1901 

88,457 

66 

74.6 

1877 

36,215 

8 

22.1 

1902 

91,581 

54 

59.0 

1878 

37,036 

11 

29.7 

1903 

94,705 

66 

69.7 

1879 

37,857 

17 

44.9 

1904 

97,829 

66 

67.5 

1880 

38,678 

19 

49.1 
38.9 

1905 
1901-1905 

100,953 

70 

69.3 

1876-1880 

185,180 

72 

473,525 

322 

68.0 

1881 

40,932 

18 

44.0 

1906 

104,077 

95 

91.3 

1882 

43,186 

19 

44.0 

1907 

107,202 

91 

84.9 

1883 

45,440 

9 

19.8 

1908 

110,327 

77 

69.8 

1884 

47,694 

15 

31.5 

1909 

113,452 

119 

104.9 

1885 

49,948 

18 

36.0 
34.8 

1910 
1906-1910 

116,577 

106 

90.9 

1881-1885 

227,200 

79 

551,635 

488 

88.5 

1886 

52,202 

22 

42.1 

1911 

119,701 

111 

92.7 

1887 

54,456 

25 

45.9 

1912 

122,825 

112 

91.2 

1888 

56,710 

28 

49.4 

1913 

125,949 

109 

86.5 

1889 

58,965 

26 

44.1 

1890 

61,220 

28 

45.7 

Source: 

Annual  Reports  of  th 

3  Board 

of   Health 

of  the  City 

of  Dayton,  Ohio. 

1886-1890 

283,553 

129 

45.5 

United  States   Mortality  Statistics,   1909- 

1913. 

1891 

63,631 

52 

81.7 

1892 

66,042 

SI 

46.9 

1893 

68,453 

33 

48.2 

1894 

70,864 

53 

74.8 

1895 

73,275 

41 

56.0 
61.4 

1891-1895 

342,265 

210 

497 


APPENDIX  F  (PART  II) 

Table  60 

Mortality  from  Cancer  in  Dayton,  Ohio,  Males 

1876-1908 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

:  00,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1876 

17,521 

8 

45.7 

1901 

43,812 

30 

68.5 

1877 

17,935 

2 

11.2 

1902 

45,482 

24 

52.8 

1878 

18,349 

8 

43.6 

1903 

47,152 

27 

57.3 

1879 

18,763 

7 

37.3 

1904 

48,822 

23 

47.1 

1880 

19,177 

8 
33 

41.7 
36.0 

1905 
.  1901-1905 

50,493 

23 

45.6 

1876-1880 

91,745 

235,761 

127 

53.9 

1881 

20,308 

8 

39.4 

1906 

52,164 

42 

80.5 

1882 

21,439 

5 

23.3 

1907 

53,835 

41 

76.2 

1883 

22,570 

1 

4.4 

1908 

55,5QQ 

27 

48.6 

1884 

23,701 

1 

4.2 

1885 

24,832 

7 

28.2 

Source: 

Annual  Reports  of 

the  Board 

nf  Health 

of  the  City 

of  Dayt 

)n    Ohio 

1881-1885 

112,850 

22 

19.5 

Ul     ±±CtlILli 

1886 

25,963 

12 

46.2 

1887 

27,094 

10 

36.9 

1888 

28,225 

8 

28.3 

1889 

29,357 

11 

37.5 

1890 

30,489 

8 

26.2 
34.7 

I 

1886-1890 

141,128 

49 

1891 

31,654 

18 

56.9 

1892 

32,819 

14 

42.7 

1893 

33,984 

13 

38.3 

1894 

35,149 

19 

54.1 

1895 

36,314 

14 

38.6 
45.9 

1891-1895 

169,920 

78 

1896 

37,479 

20 

53.4 

1897 

38,644 

22 

56.9 

1898 

39,810 

20 

50.2 

1899 

40,976 

18 

43.9 

1900 

42,142 

15 

35.6 

47.7 

1896-1900 

199,051 

95 

498 


APPENDIX  F  {PART  II) 

Table  61 

Mortality  from  Cancer  in  Dayton,  Ohio,  Females 

1876-1908 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year             Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1876 

17,873 

9 

50.4 

1901              44,645 

36 

80.6 

1877 

18,280 

6 

32.8 

1902               46,099 

30 

65.1 

1878 

18,687 

3 

16.1 

1903               47,553 

39 

82.0 

1879 

19,094 

10 

52.4 

1904               49,007 

43 

87.7 

1880 

19,501 

11 

56.4 
41.7 

1905               50,460 

47 

93.1 

1876-1880 

93,435 

39 

1901-1905        237,764 

195 

82.0 

1881 

20,624 

10 

48.5 

1906              51,913 

53 

102.1 

1882 

21,747 

14 

64.4 

1907              53,367 

50 

93.7 

1883 

22,870 

8 

35.0 

1908              54,821 

50 

91.2 

1884 

23,993 

14 

58.4 

1885 

25,116 

11 

43.8 

Source:     Annual  Reports  of  the  Board 

of  Health  of  the  City 

of  Dayton,  Ohio. 

1881-1885 

114,350 

57 

49.8 

1886 

26,239 

10 

38.1 

1887 

27,362 

15 

54.8 

1888 

28,485 

20 

70.2 

1889 

29,608 

15 

50.7 

1890 

30,731 

20 

65.1 
56.2 

1886-1890 

142,425 

80 

1891 

31,977 

34 

106.3 

1892 

33,223 

17 

51.2 

1893 

34,469 

20 

58.0 

1894 

35,715 

34 

95.2 

1895 

36,961 

27 

73.0 
76.6 

1891-1895 

172,345 

132 

1896 

38,207 

26 

68.1 

« 

1897 

39,453 

32 

81.1 

1898 

40,699 

23 

56.5 

1899 

41,945 

37 

88.2 

1900 

43,191 

41 

94.9 

78.1 

1896-1900 

203,495 

159 

499 


APPENDIX  F  {PART  II) 

Table  62 

Mortality  from  Cancer  in  Denver,  Colo. 

1892-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1892 

112,141 

25 

22.3 

1906 

181,570 

133 

73.2 

1893 

114,855 

48 

41.8 

1907 

189,522 

115 

60.7 

1894 

117,569 

43 

36.6 

1908 

197,475 

159 

80.5 

1895 

120,284 

52 

43.2 

1909 

205,428 

171 

83.2 

1910 

213,381 

191 

89.5 

1892-1895 

464,849 

168 

36.1 

1906-1910 

987,376 

769 

77.9 

1896 

122,999 

62 

50.4 

1897 

125,714 

77 

61.3 

1911 

221,334 

166 

75.0 

1898 

128,429 

71 

55.3 

1912 

229,287 

200 

87.2 

1899 

131,144 

86 

65.6 

1913 

237,240 

181 

76.3 

1900 

133,859 

68 

50.8 

Source : 
of   Health 

Annual   "Rpn""*"   <->*   t^'^   ■R.-.qt.,4 

1896-1900 

642,145 

364 

56.7 

of  the  City 

of  Denver,  Colo., 

1899-1903, 

Monthly  Reports  of  the  Board 

1901 

141,811 

101 

71.2 

of  Health  of  the  City  of  Denver, 

Colo. 

1902 

149,763 

85 

56.8 

1903 

157,715 

88 

.       55.8 

1904 

1905 

173,618 

119 

68.5 
63.1 

1901-1905 

622,907 

393 

Table  63 

Mortality  from  Cancer  in  Denver,  Colo.,  by  Sex 

1905-1913 


MALES 

FEMALES 

Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1905 

86,992 

39 

44.8 

1905 

86,626 

80 

92.4 

1906 

91,072 

50 

54.9 

1906 

90,498 

83 

91.7 

1907 

95,152 

53 

55.7 

1907 

94,370 

62 

65.7 

1908 

99,233 

68 

68.5 

1908 

98,242 

91 

92.6 

1909 

103.314 

68 

65.8 

1909 

102,114 

103 

100.9 

1910 

107,395 

74 

68.9 

1910 

105,986 

117 

110.4 

1906-1910 

496,166 

313 

63.1 

1906-1910 

491,210 

456            92.8 

1911 
1912 
1913 

111,476 
115,557 
119,638 

73 
84 
68 

65.5 

72.7 
56.8 

1911 
1912 
1913 

109,858 
113,730 
117,602 

93            84.7 
116          102.0 
113           96.1 

Source:     Annual  Reports  of  the  Board 
of  Health  of  the  City  of  Denver,  Colo. 

500 


APPENDIX  F  {PART  II) 

Table  64 

Mortality  from  Cancer  in  Denver,  Colo.,  by  Organs  and  Parts 

according  to  Sex,  1905-1912 


TOTAL 

MALES 

FEMALES 

Deaths 

Rate  per 

Deaths 

Rate  per 

Deaths 

Rate  per 

Organ  or  Part 

from 

100,000 

from 

100,000 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

Cancer 

Population 

Buccal  cavity 

38 

2.4 

33 

4.1 

5 

0.6 

Stomach  and  liver 

458 

28.4 

253 

31.2 

205 

25.6 

Peritoneum,  intestines,  rectum 

157 

9.7 

80 

9.9 

77 

9.6 

Female  generative  organs 

229 

14.2 

229 

28.6 

Breast 

98 

6.1 

i 

o.i 

97 

12.1 

Skin 

25 

1.6 

14 

1.7 

11 

1.4 

Other ornot  specified  organs.  . 

249 

15.4 

77.8 

128 
509 

15.8 
62.8 

121 
745 

15.1 

All  organs 

1,254 

93.0 

Source:     Annual  Reports  of  the  Health  Department  of  the  City  of  Denver,  Colo. 


Table  65 

Mortality  from  Cancer  in  Detroit,  Mich. 

1883-1913 


Year 

Deaths 

Rate  per 

Year 

Deaths 

Rate  per 

(Ending 

Population 

from 

100,000 

(Ending 

Population 

from 

100,000 

June  30) 

Cancer 

Population 

June  30) 

Cancer 

Population 

1883 

128,596 

50 

38.9 

1901 

293,675 

180 

61.3 

1884 

132,956 

52 

39.1 

1902 

301,647 

194 

64.3 

1903 

309,619 

224 

72.3 

1886 

153,818 

83 

54.0 

1904 

317,591 

237 

74.6 

1887 

165,447 

89 

53.8 

1905 

342,286 

200 

58.4 

1888 

177,955 

90 

50.6 

1889 

1901-1905 

1,564,818 

1,035 

66.1 

1890 

205,876 

88 

42.7 

1906 

366,982 

272 

74.1 

1886-1890 

703,096 

350 

49.8 

1907 

391,678 

240 

61.3 

1908 

416,374 

251 

60.3 

1891 

213,432 

109 

51.1 

1909 

441,070 

266 

60.3 

1892 

221,265 

94 

42.5 

1910 

465,766 

314 

67.4 

1893 
1894 

237,798 

103 

43.3 
45.5 

1906-1910 
1911 

2,081,870 
490,461 

1,343 
313 

64.5 

1891-1894 

672,495 

306 

63.8 

1912 

515,156 

332 

64.4 

1896 

252,796 

162 

64.1 

1913 

539,851 

327 

60.6 

1897 

260,645 

163 

62.5 

1898 

268,738 

158 

58.8 

Source: 

Annual  Reports  of  the  Board  of 

1899 

277,082 

158 

57.0 

Health  of  the  City  of  Detroit,  Mich.,  United 

1900 

285,704 

179 

62.7 

States  MortaUty  Statistics,  1908. 

Note: 
years. 

1894     and 

1908     are 

calendar 

1896-1900 

1,344,965 

820 

61.0 

501 


APPENDIX  F  (PART  II) 

Table  66 

Mortality  from  Cancer  in  Hartford,  Conn. 

1881-1913 


Year 
(Fiscal) 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

(Fiscal) 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1881 

43,136 

28 

64.9 

1906 

91,287 

70 

76.7 

1882 

44,257 

20 

45.2 

1907 

93,194 

98 

105.2 

1883 

45.378 

24 

52.9 

1908 

95,101 

77 

81.0 

1884 

46,499 

31 

66.7 

1909 

97,008 

98 

101.0 

1885 

47,620 

26 

54.6 
56.9 

1910 
1906-1910 

98,915 

94 
437 

95.0 

1881-1885 

226,890 

129 

475,505 

91.9 

1886 
1887 
1888 
1889 

48,742 
49,864 
50,986 
52,108 

20 
30 
29 
21 

41.0 
60.2 
56.9 
40.3 

(Calendar) 

1911 
1912 
1913 

100,821 
102,727 
104,633 

95 
118 
133 

94.2 
114.9 
127.1 

1890 

53,230 

39 

73.3 
54.5 

Source:     Annual  reports  of  the 

Health  of  the  City  of  Hartford,  C 

Note:     Data  for  1881-1910  art 

Board  of 

1886-1890 

254,930 

139 

onn. 

;  for  fiscal 

1891 

55,892 

29 

51.9 

years  ending  February 

28th  of  following 

1892 

58,554 

31 

52.9 

year. 

1893 

61,216 

28 

45.7 

1894 

63,878 

24 

37.6 

1895 

66,540 

40 

60.1 
49.7 

1891-1895 

306,080 

152 

1896 

69,202 

39 

56.4 

1897 

71,864 

42 

58.4 

1898 

74,526 

41 

55.0 

1899 

77,188 

43 

55.7 

1900 

79,850 

50 

62.6 

57.7 

1896-1900 

372,630 

215 

1901 

81,756 

67 

82.0 

1902 

83,662 

38 

45.4 

1903 

85,568 

70 

81.8 

1904 

87,474 

73 

83.5 

1905 

89,380 

82 

91.7 
77.1 

1901-1905 

427,840 

330 

502 


APPENDIX  F  {PART  II) 


Table  67 

Table  68 

Mortality  from  Cancer  in  Hartford, 
Conn.,  Males 

Mortality  from  Cancer  in  Hartford, 
Conn.,  Females 

1886-19 

13 

Deaths 

from 
Cancer 

Rate  per 

100,000 

Population 

Year 

(Fiscal) 

1886-19 

13 

Deaths 
from 
Cancer 

Year 

(Fiscal) 

Population 

Population 

Rate  per 

100,000 

Population 

1886 

23,835 

7 

29.4 

1886 

24,907 

13 

52.2 

1887 

24,381 

10 

41.0 

1887 

25,483 

20 

78.5 

1888 

24,927 

6 

24.1 

1888 

26,059 

23 

88.3 

1889 

25,473 

9 

35.3 

1889 

26,635 

12 

45.1 

1890 

26,019 

6 

23.1 
30.5 

1890 
1886-1890 

27,211 

33 

121.3 

1886-1890 

124,635 

38 

130,295 

101 

77.5 

1891 

27,486 

7 

25.5 

1891 

28,406 

22 

77.4 

1892 

28,953 

11 

38.0 

1892 

29,601 

20 

67.6 

1893 

30,420 

8 

26.3 

1893 

30,796 

20 

64.9 

1894 

31,887 

7 

22.0 

1894 

31,991 

17 

53.1 

1895 

33,355 

14 

42.0 
30.9 

1895 
1891-1895 

33,185 

26 

78.3 

1891-1895 

152,101 

47 

153,979 

105 

68.2 

1896 

34,823 

15 

43.1 

1896 

34,379 

24 

69.8 

1897 

36,291 

16 

44.1 

1897 

35,573 

26 

73.1 

1898 

37,759 

11 

29.1 

1898 

36,767 

30 

81.6 

1899 

39,227 

14 

35.7 

1899 

37,961 

29 

76.4 

1900 

40,695 

14 

34.4 
37.1 

1900 
1896-1900 

39,155 

36 

91.9 

1896-1900 

188,795 

70 

183,835 

145 

78.9 

1901 

41,546 

25 

60.2 

1901 

40,210 

42 

104.5 

1902 

42,397 

15 

35.4 

1902 

41,265 

23 

55.7 

1903 

43,248 

28 

64.7 

1903 

42,320 

42 

99.2 

1904 

44,099 

30 

68.0 

1904 

43,375 

43 

99.1 

1905 

44,951 

28 

62.3 

58.3 

1905 
1901-1905 

44,429 

54 

121.5 

1901-1905 

216,241 

126 

211,599 

204 

96.4 

1906 

45,803 

37 

80.8 

1906 

45,484 

33 

72.6 

1907 

46,655 

34 

72.9 

1907 

46,539 

64 

137.5 

1908 

47,507 

35 

73.7 

1908 

47,594 

42 

88.2 

1909 

48,359 

38 

78.6 

1909 

48,649 

60 

123.3 

1910 

49,211 

26 

52.8 
71.6 

1910 
1906-1910 

49,704 

68 

136.8 

1906-1910 

237,535 

170 

237,970 

267 

112.2 

(Calendar) 

(Calendar) 

1911 

50,063 

35 

69.9 

1911 

50,758 

60 

118.2 

1912 

50,915 

51 

100.2 

1912 

51,812 

67 

129.3 

1913 

51,767 

59 

114.0 

1913 

52,866 

74 

140.0 

Source :     Annual  Reports  of  the  Board  of 
Health  of  the  City  of  Hartford,  Conn. 
Note:     Data  for  1886-1910  are  for. fiscal 

Source :     Annual  Reports  of  the  Board  of 
Health  of  the  City  of  Hartford,  Conn. 
Note:     Data  for  1886-1910  are  for  fiscal 

years   ending   February 

28th  of 

following 

years  ending  February 

28th  of 

following 

year. 

year. 

503 


APPENDIX  F  {PART  II) 


Table  69 

Table  70 

Mortality  from  Cancer 

in 

Mortality  from  Cancer 

in 

Hoboken,  N,  J. 

1880-1913 

Hoboken,  N.  J., 

by  Sex 

- 

1902-1913 

Year 
(Ending 

Population 

Deaths 
from 

Rate  per 
100,000 

June  30} 

Cancer 

Population 

MALES 

1880 

30,999 

12 

38.7 

D 

eaths 

Rate  per 

Year 

Population            f 

rom 

100,000 

1881 

32,343 

14 

43.3 

C 

ancer 

Population 

1882 

33,687 

10 

29.7 

1902 

31,300 

22 

70.3 

1883 

35,031 

17 

48.5 

1903 

31,946 

8 

25.0 

1884 

36,376 

10 

27.5 

1904 

32,592 

18 

55.2 

1885 

37,721 

19 

50.4 

40.0 

1905 
1902-1905 

33,238 

21 

63.2 

1881-1885 

175,158 

70 

129,076 

69 

53.5 

1886 
1887 
1888 
1889 
1890 

38,906 
40,091 
41,276 
42,462 
43,648 

17 
•    22 
20 
28 
19 

43.7 
54.9 
48.5 
65.9 
43.5 

51.4 

1906 
1907 
1908 
1909 
1910 

1906-1910 

33,925 
34,612 
35,300 
35,988 
36,675 

27 
30 
16 
27 
19 

79.6 
86.7 
45.3 
75.0 
51.8 

206,383 

106 

1886-1890 

176,500 

119 

67.4 

1891 

45,735 

20 

43.7 

1892 

47,822 

22 

46.0 

1911 

37,363 

20 

53.5 

1893 

49,909 

29 

58.1 

1912 

38,051 

21 

55.2 

1894 

51,996 

22 

42.3 

1913 

38,739 

21 

54.2 

1895 

54,083 

23 

42.5 
46.5 

1902 

FEMALES 
30,505 

17 

1891-1895 

249,545 

116 

55.7 

1903 

31,080 

24 

77.2 

1896 

55,139 

25 

45.3 

1904 

31,655 

37 

116.9 

1897 

56,195 

45 

80.1 

1905 

32,230 

33 

102.4 

1898 

57,251 

28 

48.9 

1899 

58,307 

27 

46.3 

1902-1905 

125,470 

111 

88.5 

1900 

59,364 

30 

50.5 

54.1 

1906 
1907 

32,514 
32,798 

43 

22 

132.3 

1896-1900 

286,256 

155 

67.1 

(Calendar^ 

1908 

33,081 

28 

84.6 

1901 

60,584 

32 

52.8 

1909 

33,364 

27 

80.9 

1902 

61,805 

39 

63.1 

1910 

33,649 

37 

110.0 

1903 

63,026 

32 

50.8 

1904 

64,247 

55 

85.6 

1906-1910 

165,406 

157 

94.9 

1905 

65,468 

54 

82.5 

1911 
1912 

33,933 

34,217 

38 
37 

112.0 
108.1 

1901-1905 

315,130 

212 

67.3 

1913 

34,501 

27 

78.3 

1906 

66,439 

70 

105.4 

1907 

67,410 

52 

77.1 

Source : 

Annual  Reports  of  the  Board  of 

1908 

68,381 

44 

64.3 

Health  of  the  State  of  New  Jersey. 

1909 

69,352 

54 

77.9 

1910 

70,324 

56 

79.6 
80.7 

1906-1910 

341,906 

276 

1911 

71,296 

58 

81.4 

1912 

72,268 

58 

80.3 

1913 

73,240 

48 

65.5 

Source : 

Annual  Reports  of  the  Board  of 

Health  of 

the  State  of 

New  Jersey. 

504 


APPENDIX  F  {PART  II) 

Table  71 

Mortality  from  Cancer  in  Indianapolis,  Ind. 

1900-1913 


Deaths 

Rate  per 

Deaths        Rate  per 

Year 

Population 

from 

100,000 

Year             Population            from             100,000 

Cancer 

Population 

Cancer       Population 

1900 

169,164 

108 

63.8 

1911  240,098            193             80.4 

1912  246,546            216             87.6 

1901 

175,612 

85 

48.4 

1913            252,994            222            87.7 

1902 

182,060 

97 

53.3 

1903 

188,508 

106 

56.2 

Source:   1913  Annual  Report  of  Depart- 

1904 

194,956 

122 

62.6 

ment  of  Public   Health   and  Charities   of 

1905 

201,405 

102 

50.6 
54.3 

Indianapolis,  Ind. 

1901-1905 

942,541 

512 

1906 

207,854 

110 

52.9 

1907 

214,303 

132 

61.6 

1908 

220,752 

156 

70.7 

1909 

227,201 

198 

87.1 

1910 

233,650 

181 

77.5 
70.4 

1906-1910 

1,103,760 

777 

Table  72 

Mortality  from  Cancer  in  Indianapolis,  Ind.,  by  Sex 

1906-1913 


MALES 

FEMALES 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1906 

103,049 

33 

32.0 

1906 

104,805 

77 

73.5 

1907 

106,304 

41 

38.6 

1907 

107,999 

91 

84.3 

1908 

109,559 

49 

44.7 

1908 

111,193 

107 

96.2 

1909 

112,814 

62 

55.0 

1909 

114,387 

136 

118.9 

1910 

116,069 

50 

43.1 
42.9 

1910 
1906-1910 

117,581 

131 

111.4 

1906-1910 

547,795 

235 

555,965 

542 

97.5 

1911 
1912 
1913 

119,323 
122,577 
125,831 

76 
67 

72 

63.7 
54.7 

57.2 

1911 
1912 
1913 

120,775 
123,969 
127,163 

117 
149 
150 

96.9 
120.2 
118.0 

Source:  Annual  Reports  of  Department 
of  Public  Health  and  Charities  of  Indian- 

apolis, Inc 

505 


APPENDIX  F  (PART  II) 

Table  73 

Mortality  from  Cancer  in  Jersey  City,  N.  J. 

1879-1913 


Year 

Deaths 

Rate  per 

Deaths         Rate  per 

(Ending 

Population 

from 

100,000 

Year            Population            from            100,000 

June  30) 

Cancer 

Population 

Cancer       Population 

1879 

118,423 

39 

32.9 

1906            239,715            138            57.6 

1880 

120,722 

35 

29.0 

1907  246,731            159            64.4 

1908  253,747            141            55.6 

1881 

127,280 

56 

44.0 

1909            260,763            153            58.7 

1882 

133,838 

37 

27.6 

1910            267,779            176            65.7 

1883 

140,396 

48 

34.2 

1884 

146,954 

61 

41.5 

1906-1910     1,268,735            767            60.5 

1885 

153,513 

52 

33.9 

1911            274,795            181            65.9 

1«81-1885 

701,981 

254 

36.2 

1912  281,811            187            66.4 

1913  288,827            195            67.5 

1886 

155,411 

67 

43.1 

1887 

157,309 

59 

37.5 

Source :     Annual  Reports  of  the  Board  of 

1888 

159,207 

69 

43.3 

Health  of  the  State  of  New  Jersey.    1912- 

1889 

161,105 

60 

37.2 

1913  Reports  of  Vital  Statistics— Board  of 

1890 

163,003 

80 

49.1 
42.1 

Health — Hudson  County;  N.  J. 

1886-1890 

796,035 

335 

1891 

166,945 

82 

49.1 

1892 

170,887 

92 

53.8 

1893 

174,829 

68 

38.9 

1894 

178,771 

77 

43.1 

1895 

182,713 

67 

36.7 
44.2 

1891-1895 

874,145 

386 

1896 

187,457 

94 

50.1 

.    1897 

192,201 

77 

40.1 

1898 

196,945 

89 

45.2 

1899 

201,689 

89 

44.1 

1900 

206,433 

85 

41.2 
44.1 

1896-1900 

984,725 

434 

(Calendar) 

1901 

211,686 

105 

49.6 

1902 

216,939 

104 

47.9 

1903 

222,192 

126 

56.7 

1904 

227.445 

114 

50.1 

1905 

232,699 

142 

61.0 
53.2 

1901-1905 

1,110,961 

591 

506 


APPENDIX  F  {PART  II) 

Table  74 
Mortality  from  Cancer  in  Jersey  City,  N.  J. 
1902-1913 


by  Sex 


MALES 

FEMALES 

Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1902 

109,004 

41 

37.6 

1902 

107,935 

63 

58.4 

1903 

111,493 

43 

38.6 

1903 

110,699 

83 

75.0 

1904 

113,982 

44 

38.6 

1904 

113,463 

70 

61.7 

1905 

116,471 

44 

37.8 
38.1 

1905 
1902-1905 

116,228 

98 

84.3 

1902-1905 

450,950 

172 

448,325 

314 

70.0 

1906 

120,668 

49 

40.6 

1906 

119,047 

89 

74.8 

1907 

124,865 

63 

50.5 

1907 

121,866 

96 

78.8 

1908 

129,062 

60 

46.5 

1908 

124,685 

81 

65.0 

1909 

133,259 

56 

42.0 

1909 

127,504 

97 

76.1 

1910 

137,457 

55 

40.0 
43.9 

1910 
1906-1910 

130,322 

121 

92.8 

1906-1910 

645,311 

283 

623,424 

484 

77.6 

1911 

141,655 

78 

55.1 

1911 

133,140 

103 

77.4 

1912 

145,853 

66 

45.3 

1912 

135,958 

121 

89.0 

1913 

150,051 

71 

47.3 

1913 

138,768 

124 

89.4 

Source: 

Annual  Reports  of  the  Board  of 

Health  of  the  State  of  New  Jersey. 

Table  75 

Mortality  from  Cancer  in  Kansas  City,  Mo. 

1900-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1900 

163,752 

65 

39.7 

1906 

214,529 

148 

69.0 

1907 

222,992 

153 

68.6 

1901 

172,214 

78 

45.3 

1908 

231,455 

141 

60.9 

1902 

180,677 

101 

55.9 

^      1909 

239,918 

179 

74.6 

1903 

189,140 

96 

50.8 

1910 

248,381 

202 

81.3 

1904 

197,603 
206,066 

128 
110 

64.8 
53.4 

54.2 

1905 

1906-1910 
1911 

1,157,275 
256,843 

823 
236 

71.1 

1901-1905 

945,700 

513 

91.9 

1912 

265,306 

223 

84.1 

1913 

27^,768 

237 

86.6 

Source: 

United  Stat 

38   Mortality  Sta- 

tistics. 

507 


APPENDIX  F  {PART  II) 

Table  76 

Mortality  from  Cancer  in  Los  Angeles,  Cal. 

1900-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Caacer 

Population 

Cancer 

Population 

1900 

102,479 

92 

89.8 

1906 

232,510 

217 

93.3 

1907 

254,182 

223 

87.7 

1901 

124,150 

111 

89.4 

1908 

275,854 

245 

88.8 

1902 

145,822 

119 

81.6 

1909 

297,526 

286 

96.1 

1903 

167,494 

146 

87.2 

1910 

319,198 

338 

105.9 

1904 

189,166 

117 

61.9 

1905 

210,838 

175 

83.0 
79.8 

1906-1910 
1911 

1,379,270 
340,869 

1,309 

328 

94.9 

1901-1905 

837,470 

668 

96.2 

1912 

362,541 

413 

113.9 

1913 

384,212 

425 

110.6 

Source: 

United  States  Mortality  Sta- 

tistics. 

Table  77 

Mortality  from  Cancer  in  Louisville,  Ky. 

1890-1913 


Year 

Deaths 

Rate  per 

Year 

Deaths 

Rate  per 

(Endintf 

Population 

from 

100,000 

Population 

from 

100,000 

August  'jl) 

Cancer 

Population 

August  31) 

Cancer 

Population 

1890 

161,129 

82 

50.9 

1906 

216,248 

129 

59.7 

1907 

218,168 

110 

50.4 

1891 

165,489 

84 

50.8 

1908 

220,088 

155 

70.4 

.1892 

169,849 

85 

50.0 

1909 

222,008 

126 

56.8 

1893 

174,209 

93 

53.4 

1910 

223,928 

153 

68.3 

1894 

178,569 

99 

55.4 

1895 

182,929 

95 

51.9 

52.4 

1906-1910 
1911 

1,100,440 

225,847 

673 
163 

61.1 

1891-1895 

871,045 

456 

72.2 

1912 

227,766 

152 

66.7 

1896 

187,289 

92 

49.1 

1913 

229,685 

165 

71.8 

1897 

191,649 

84 

43.8 

1898 

196.009 

124 

63.3 

Source: 

Annual  Reports  of  the  Health 

1899 

200,370 

105 

52.4 

OfBcer  of  the  City  of  Louisville,  Ky. 

1900 

204,731 

121 

59.1 
53.7 

1896-1900 

980,048 

526 

1901 

206,650 

109 

52.7 

1902 

208,569 

127 

60.9 

1903 

210,488 

114 

54.2 

1904 

212,408 

125 

58.8 

1905 

214,328 

127 

59.3 

57.2 

1901-1905 

1,052,443 

602 

508 


APPENDIX  F  {PART  II) 

Table  78 

Mortality  from  Cancer  in  Memphis,  Tenn. 

1891-1914 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1891 

68,277 

16 

23.4 

1901 

105,198 

36 

34.2 

1892 

72,059 

21 

29.1 

1902 

108,076 

38 

35.2 

1893 

75,841 

12 

15.8 

1903 

110,954 

51 

46.0 

1894 

79,623 

15 

18.8 

1904 

113,832 

35 

30.7 

1895 

83,405 

19 

22.8 
21.9 

1905 
1901-1905 

116,710 

43 

36.8 

1891-1895 

379,205 

83 

554,770 

203 

36.6 

1896 

87,188 

16 

18.4 

1906 

119,589 

55 

46.0 

1897 

90,971 

21 

23.1 

1907 

122,468 

57 

46.5 

1898 

94,754 

29 

30.6 

1908 

125,347 

67 

53.5 

1899 

1909 

128,226 

53 

41.3 

1900 

102,320 

47 

45.9 
30.1 

1910 
1906-1910 

131,105 

73 

55.7 

1896-1900 

375,233 

113 

626,735 

305 

48.7 

1911 

133,983 

64 

47.8 

1912 

136,861 

76 

65.5 

1913 

139,739 

61 

43.7 

1914 

142,617 

110 

77.1 

Source:    Annual  Reports  of  the  Board 
of  Health  of  the  City  of  Memphis,  Tenn. 

Table  79 

Mortality  from  Cancer  in  Memphis,  Tenn.,  White 

1891-1914 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1891 

37,427 

7 

18.7 

1901 

55,001 

16 

29.1 

1892 

39,088 

14 

35.8 

1902 

57,622 

22 

38.2 

1893 

40,749 

9 

22.1 

1903 

60,243 

41 

68.1 

1894 

42,410 

10 

23.6 

1904 

62,864 

29 

46.1 

1895 

44,071 

13 

29.5 
26.0 

1905 
1901-1905 

65,485 

30 

45.8 

1891-1895 

203,745 

53 

301,215 

138 

45.8 

1896 

45,732 

9 

19.7 

1906 

68,106 

43 

63.1 

1897 

47,394 

17 

35.9 

1907 

70,727  • 

38 

53.7 

1898 

49,056 

23 

46.9 

1908 

73,348 

47 

64.1 

1899 

1909 

75,969 

38 

50.0 

1900 

52,380 

32 

61.1 
41.6 

1910 
1906-1910 

78,590 

51 

64.9 

1896-1900 

194,562 

81 

366,740 

217 

59.2 

1911 

81,211 

40 

49.3 

1912 

8.3,832 

45 

53.7 

1913 

86,453 

35 

40.5 

1914 

89,074 

85 

95.4 

Source: 

Annual  Reports  of 

the  Board 

of  Health  of  the  City  of  Memphi.s,  Tenn. 

509 


APPENDIX  F  {PART  II) 

Table  80 

Mortality  from  Cancer  in  Memphis,  Tenn.,  Colored 

1891-1914 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1891 

30,850 

9 

29.2 

1901 

50,197 

20 

39.8 

1892 

32,971 

7 

21.2 

1902 

50,454 

16 

31.7 

1893 

35,092 

3 

8.5 

1903 

50,711 

10 

19.7 

1804 

37,213 

5 

13.4 

1904 

50,968 

6 

11.8 

1895 

39,334 

6 

30 

15.3 
17.1 

1905 
1901-1905 

51,225 

13 
65 

25.4 

1891-1895 

175,460 

253,555 

25.6 

1896 

41,456 

7 

16.9 

1906 

51,483 

12 

23.3 

1897 

43,577 

4 

9.2 

1907 

51,741 

19 

36.7 

1898 

45,698 

6 

13.1 

1908 

51,999 

20 

38.5 

1899 

1909 

52,257 

15 

28.7 

1900 

49,940 

15 

32 

30.6 
17.7 

1910 
1906-1910 

52,515 

22 
88 

41.9 

1896-1900 

180,671 

259,995 

33.8 

1911 

52,772 

24 

45.5 

1912 

53,029 

31 

58.5 

1913 

53,286 

26 

48.8 

1914 

53,543 

25 

46.7 

Source: 

Annual  Reports  of  the  Board 

of  Health  of  the  City  of  Memphis 

,  Tenn. 

Table  81 

Mortality  from  Cancer  in  Milwaukee,  Wis. 

1894-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1894 

240,325 

107 

44.5 

1906 

325,129 

234 

72.0 

1895 

249,290 

149 

59.8 

1907 

337,311 

230 

68.2 

1908 

349,493 

218 

62.4 

1896 

256,495 

160 

62.4 

1909 

361,675 

259 

71.6 

1897 

263,700 

164 

62.2 

1910 

373,857 

254 

67.9 

1898 

270,905 

166 

61.3 

1899 

278,110 

194 

69.8 

1906-1910 

1,747,465 

1,195 

68.4 

1900 

285,315 

196 

68.7 

1911 

386,038 

278 

72.0 

1896-1900 

1,354,525 

880 

65.0 

1912 

398,219 

283 

71.1 

1913 

410,400 

287 

G9.9 

1901 

290,841 

206 

70.8 

1902 

296,367 

208 

70.2 

Source: 

Annual  Reports  of 

the  Com- 

1903 

301,894 

212 

70.2 

missioner 

of  Health  of  the  City  of  Milwau- 

1904 

307,421 

224 

72.9 

kee.  Wis. 

1905 

312,948 

206 

65.8 
70.0 

1901-1905 

1,509,471 

1,056 

510 


APPENDIX  F  (PART  II) 

Table  82 
Mortality  from  Cancer  in  Milwaukee,  Wis.,  Males 


1898 

-1913 

Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

lear 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1898 

133,460 

74 

55.4 

1906 

162,939 

106 

65.1 

1899 

136,998 

95 

69.3 

1907 

169,576 

93 

54.8 

1900 

140,536 

72 

51.2 

1908 

176,213 

99 

56.2 

1909 

182,850 

107 

58.5 

1898-1900 

410,994 
143,689 

241 
92 

58.6 
64.0 

1910 
1906-1910 

189,488 

120 
525 

63.3 

1901 

881,066 

59.6 

1902 

146,842 

87 

59.2 

1903 

149,995 

91 

60.7 

1911 

196,125 

124 

63.2 

1904 

153,148 

103 

67.3 

1912 

202,762 

118 

58.2 

1905 

156,302 

95 

468 

60.8 
62.4 

1913 
Source: 

209,399            120 
Annual  Reports  of 

57.3 

1901-1905 

749,976 

the  Com- 

missioner  of  Health  of  the  City  of  Milwau- 

kee, Wis. 

Table  83 

Mortality  from  Cancer  in  Milwaukee,  Wis.,  Females 

1898-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1898 

137,445 

92 

66.9 

1906 

162,190 

128 

78.9 

1899 

141,112 

99 

70.2 

1907 

167,735 

137 

81.7 

1900 

144,779 

124 

85.6 

1908 

173,280 

119 

68.7 

1909 

178,825 

152 

85.0 

1898-1900 

423,336 
147,152 

315 
114 

74.4 
77.5 

1910 
1906-1910 

184,369 

134 
670 

72.7 

1901 

866,399 

77.3 

1902 

149,525 

121 

80.9 

1903 

151,899 

121 

79.7 

1911 

189,913 

154 

81.1 

1904 

154,273 

121 

78.4 

1912 

195,457 

165 

84.4 

1905 

156,646 

111 
588 

70.9 

77.4 

1913 
Source: 

201,001            167 
Annual  Reports  of 

83.1 

1901-1905 

759,495 

the  Com- 

missioner 

Df  Health  of  th 

e  City 

Df  Milwau- 

kee.  Wis. 

511 


APPENDIX  F  {PART  II) 

Table  84 

Mortality  from  Cancer  in  Minneapolis,  Minn. 

1889-1913 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1889 

152,952 

76 

49.7 

1901 

212,587 

133 

62.6 

1890 

164,738 

68 

41.3 

1902 

222,456 

117 

52.6 

1903 

232,325 

154 

66.3 

1891 

168,536 

61 

36.2 

1904 

242,194 

140 

57.8 

1892 

172,334 

79 

45.8 

1905 

252,063 

162 

64.3 

1893 

176.132 

84 

47.7 

1894 

179,930 

91 

50.6 

1901-1905 

1,161,625 

706 

60.8 

1895 

183,728 

82 

44.6 

1906 

261,932 

171 

65.3 

1891-1895 

880,660 

397 

45.1 

1907 

271,801 

189 

69.5 

1908 

281,670 

179 

63.5 

1896 

187,526 

103 

54.9 

1909 

291,539 

186 

63.8 

1897 

191,324 

91 

47.6 

1910 

301,408 

195 

64.7 

1898 

195,122 

106 

54.3 

1899 

198,920 

95 

47.8 

1906-1910 

1,408,350 

920 

65.3 

1900 

202,718 

120 

59.2 

1911 

311,277 

234 

75.2 

1896-1900 

975,610 

515 

52.8 

1912 

321,146 

258 

80.3 

J913 

331,015 

276 

83.4 

Source:    Annual  Reports  of  the  Depart- 
ment of  Health  of  the  City  of  Minneapolis, 
Minn. 

Table  85 

Mortality  from  Cancer  in  Minneapolis,  Minn.,  by  Organs  and  Parts 

according  to  Sex,  1908-1912 


TOTAL 

MALES 

FEMALES 

Deaths 

Rate  per 

Deaths 

Rate  per 

Deaths 

Rate  per 

Organ  or  Part 

from 

100,000 

from 

100,000 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

Cancer 

Population 

Buccal  cavity 

40 

2.7 

34 

4.3 

6 

0.8 

Stomach  and  liver 

421 

27.9 

244 

31.0 

177 

24.6 

Peritoneum,  intestines,  rectum 

121 

8.0 

58 

7.4 

63 

8.7 

Female  generative  organs 

144 

9.6 

144 

20.0 

Breast 

102 

6.8 

i 

o.i 

101 

14.0 

Skin 

32 

2.1 

20 

2.5 

12 

1.7 

Other  or  not  specified  organs. . 

192 

12.7 
69.8 

116 
473 

14.8 
60.1 

76 
579 

10.6 

All  organs 

1,052 

80.4 

Source: 
Minn. 


Annual  Reports  of  the  Department  of  Health  of  the  City  of  Minneapolis, 


512 


APPENDIX  F  {PART  II) 

Table  86 

Mortality  from  Cancer  in  Minneapolis,  Minn.,  by  Organs  and  Parts 

according  to  Age,  1908-1912 


Organ  or  Part 

Buccal  cavity 

Stomach  and  liver 

Peritoneum,  intestines,  rectum 

Female  generative  organs 

Breast 

Skin 

Other  or  not  specified  organs. . 

All  organs 


UNDER  40 
Deaths       Rate  per 
100,000 
Population 

0.2 


from 
Cancer 


2 
27 
17 
16 
10 

5 
36 


113 


2.4 
1.5 
1.4 
0.9 
0.5 
3.2 

10.1 


40-59 

Deaths       Rate  per 

from  100,000 

Cancer    Population 


16 
189 
40 
88 
56 
5 
78 

472 


5.4 
64.2 
13.6 
29.9 
19.0 

1.7 
26.5 

160.3 


60  AND  OVER 


Deaths 
from 
Cancer 


205 


40 
36 


78 


467 


Rate  per 

100,000 

Population 

25.3 
235.4 
73.5 
45.9 
41.3 
25.3 
89.4 

536.1 


Source:     Annual  Reports  of  the  Department  of  Health  of  the  City  of  Minneapolis, 

Minn. 


Table  87 

Mortality  from  Cancer  in  Nashville,  Tenn. 

1879-1914 


Year 

Deaths 

Rate  per 

Deaths 

Rate  per 

(Ending 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Sept.  30) 

Cancer 

Population 

(C:llendar) 

Cancer 

Population 

1879 

41,601 

6 

14.4 

1896 

78',985 

42 

53.2 

1880 

43,350 

9 

20.8 

1897 

79,455 

29 

36.5 

1898 

79,925 

40 

50.0 

1881 

46,631 

9 

19.3 

1899 

80,395 

53 

65.9 

1882 

49,912 

15 

30.1 

1900 

80,865 

27 

33.4 

1883 

53,194 

8 

15.0 

1884 

56,476 

16 

28.3 

1896-1900 

399,625 

191 

47.8 

1885 

59,758 

12 

20.1 



1901 

83,814 

49 

58.5 

1881-1885 

265,971 

60 

22.6 

1902 

86,764 

36 

41.5 

1903 

89,714 

44 

49.0 

1886 

63,040 

11 

17.4 

1904 

92,664 

51 

55.0 

1887 

66,322 

9 

13.6 

1905 

95,614 

55 

57.5 

1888 

69,604 

14 

20.1 

1889 

72,886 

14 

19.2 

1901-1905 

448,570 

235 

52.4 

1890 

76,168 

19 

24.9 

1906 

98,564 

61 

61.9 

1886-1890 

348,020 

67 

19.3 

1907 

101,514 

74 

72.9 

(Calendar) 

1908 

104,464 

78 

74.7 

1891 

76,637 

23 

30.0 

1909 

107,414 

69 

64.2 

1892 

77,106 

23 

29.8 

1910 

110,364 

73 

66.1 

1893 

77,575 

28 

36.1 

1894 

78,045 

27 

34.6 

1906-1910 

522,320 

355 

68.0 

1895 

78,515 

38 

48.4 

1911 

113,314 

81 

71.5 

1891-1895 

387,878 

139 

35.8 

1912 

116,264 

76 

65.4 

1913 

119,214 

86 

72.1 

1914 

122,165 

94 

76.9 

Source: 

Annual  Reports  of  the  Health 

Officer  of  the  City  of  Nashville, 

Tenn. 

513 


APPENDIX  F  (PART  II) 


Table  88 

Table  89 

Mortality  from  Cancer  in  Nashville, 

Mortality  from  Cancer  in  Nashville, 

Tenn.,  Males, 

1885-1< 

>13 

Rate  per 

Teni 

Year 

ti.,  Females 

,  1885-1 

Deaths 

913 

Year 

Deaths 

Rate  per 

(Ending 

Population 

from 

100,000 

(Ending 

Population 

from 

100,000 

Sept.  30) 

Cancer 

Population 

Sept.  30) 

Cancer 

Population 

1885 

29,171 

3 

10.3 

1885 

30,587 

9 

29.4 

1886 

30,716 

3 

9.8 

1886 

32,324 

8 

24.7 

1887 

,  , 

1887 

1888 

33,786 

2 

5'.9 

1888 

35,8i8 

ik 

33.5 

1889 

35,312 

2 

5.7 

1889 

37,574 

12 

31.9 

1890 

36,832 

7 

19.0 
10.2 

1890 
1886-1890 

39,336 

12 

30.5 

1886-1890 

136,646 

14 

145,052 

44 

30.3 

(Calendar) 

(Calendar) 

1891 

36,984 

6 

16.2 

1891 

39,653 

17 

42.9 

1892 

37,136 

5 

13.5 

1892 

39,970 

18 

45.0 

1893 

37,288 

8 

21.5 

1893 

40,287 

20 

49.6 

1894 

37,440 

6 

16.0 

1894 

40,605 

21 

51.7 

1895 

37,592 

8 
33 

21.3 

17.7 

1895 
1891-1895 

40,923 

30 

73.3 

1891-1895 

186,440 

201,438 

106 

52.6 

1896 

37,744 

8 

21.2 

1896 

41,241 

34 

82.4 

1897 

37,897 

7 

18.5 

1897 

41,558 

22 

52.9 

1898 

38,050 

8 

21.0 

1898 

41,875 

32 

76.4 

1899 

38,203 

.      11 

28.8 

1899 

42,192 

42 

99.5 

1900 

38,356 

9 

23.5 
22.6 

1900 
1896-1900 

42,509 

18 

42.3 

1896-1900 

190,250 

43 

209,375 

148 

70.7 

1901 

39,735 

15 

37.8 

1901 

44,079 

34 

77.1 

1902 

41,115 

11 

26.8 

1902 

45,649 

25 

54.8 

1903 

42,495 

12 

28.2 

1903 

47,219 

32 

67.8 

1904 

43,875 

19 

43.3 

1904 

48,789 

32 

65.6 

1905 

45,255 

18 

39.8 
35.3 

1905 
1901-1905 

50,359 

37 

73.5 

1901-1905 

212,475 

75 

236,095 

160 

67.8 

1906 

46,635 

14 

30.0 

1906 

51,929 

47 

90.5 

1907 

48,015 

27 

56.2 

1907 

53,499 

47 

87.9 

1908 

49,395 

20 

40.5 

1908 

55,069 

58 

105.3 

1909 

50,775 

13 

25.6 

1909 

56,639 

5Q 

98.9 

1910 

52,155 

20 

38.3 
38.1 

1910 
1906-1910 

58,209 

53 

91.1 

1906-1910 

246,975 

94 

275,345 

261 

94.8 

1911 

53,535 

25 

46.7 

1911 

59,779 

56 

93.7 

1912 

54,915 

14 

25.5 

1912 

61,349 

62 

101.1 

1913 

56,295 

30 

63.3 

1913 

62,919 

56 

89.0 

Source:     Annual  Reports  of  the  Health 
OfBcer  of  the  City  of  Nashville,  Tenn. 


Source:     Annual  Reports  of  the  Health 
Officer  of  the  City  of  Nashville,  Tenn. 


514 


APPENDIX  F  {PART  II) 

Table  90 

Mortality  from  Cancer  in  Nashville,  Tenn.,  White 

1885-1914 


Year 
(Ending 
SeiH.  30) 

Population 

Deaths 

from 
Cancer 

Rate  per 

100,000 

Population 

1885 

36,888 

6 

16.3 

1886 

38,865 

8 

20.6 

1887 

1888 

42,819 

io 

23.4 

1889 

44,796 

9 

20.1 

1890 

46,773 

13 

27.8 

1886-1890 

173,253 

40 

23.1 

(Calendar) 

1891 

47,175 

20 

42.4 

1892 

47,577 

20 

42.0 

1893 

47,979 

19 

39.6 

1894 

48,381 

14 

28.9 

1895 

48,783 

25 

51.2 

1891-1895 

239,895 

98 

40.9 

1896 

49.185 

29 

59.0 

1897 

49,587 

17 

34.3 

1898 

49,990 

26 

52.0 

1899 

50,393 

28 

55.6 

1900 

50,796 

17 

33.5 

1896-1900 

249,951 

117 

46.8 

1901 

53,099 

33 

62.1 

1902 

55,402 

21 

37.9 

1903 

57,705 

27 

46.8 

1904 

60,008 

39 

65.0 

1905 

62,311 

46 

73.8 

1901-1905 

£88,525 

166 

57.5 

1906 

64,615 

38 

58.8 

1907 

66.919 

57 

85.2 

1908 

69,223 

5Q 

80.9 

1909 

71,527 

49 

68.5 

1910 

73,831 

58 

78.6 

1906-1910 

346,115 

258 

74.5 

1911 

76,135 

65 

85.4 

1912 

78,438 

56 

71.4 

1913 

80,742 

73 

90.4 

1914 

83,047 

66 

79.5 

Source:    Annual  Reports  of  the  Health  Officer  of  the  City 
of  Nashville,  Tenn. 


515 


APPENDIX  F  (PART  II) 

Table  91 

Mortality  from  Cancer  in  Nashville,  Tenn.,  Colored 

1885-1914 


Year 

Deaths 

Rate  per 

Deaths 

Rate  per 

(Ending 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Sept.  30) 

Cancer 

Population 

(Calendar) 

Cancer 

Population 

1885 

22,870 

6 

26.2 

1901 

30,715 

16 

52.1 

1902 

31,362 

15 

47.8 

1886 

24,175 

3 

12.4 

1903 

32,009 

17 

53.1 

1887 

1904 

32,656 

12 

36.7 

1888 

26,785 

'4 

14.9 

1905 

33,303 

9 

27.0 

1889 

28,090 

5 

17.8 

1890 

29,395 

6 

18 

20.4 
16.6 

1901-1905 
1906 

160,045 
33,949 

69 
23 

43.1 

1886-1890 

108,445 

67.7 

(Calendar) 

1907 

34,595 

17 

49.1 

1891 

29,462 

3 

10.2 

1908 

35,241 

22 

62.4 

1892 

29,529 

3 

10.2 

1909 

35,887 

20 

55.7 

1893 

29,596 

9 

30.4 

1910 

36,533 

15 

41.1 

1894 

29,664 

13 

43.8 

1895 

29,782 

13 
41 

43.7 

27.7 

1906-1910 
1911 

176,205 
37,179 

97 
16 

55.0 

1891-1895 

147,983 

43.0 

1912 

37,826 

20 

52.9 

1896 

29,800 

13 

43.6 

1913 

38,472 

13 

33.8 

1897 

29,868 

12 

40.2 

1914 

39,118 

28 

71.6 

1898 

29,935 

14 

46.8 

1899 

30,002 

25 

83.3 

Source: 

Annual  Reports  of  the  Health 

1900 

30,069 

10 

74 

33.3 
49.4 

Officer  of  the  City  of  Nashville, 

Tenn. 

1896-1900 

149,674 

Table  92 

Mortality  from  Cancer  in  Nashville,  Tenn.,  by  Organs  and  Parts 

according  to  Sex,  1903-1912 


TOTAL 


Organ  or  Part 

Buccal  cavity -. 

Stomach  and  liver 

Peritoneum,  intestines,  rectum 

Female  generative  organs 

Breast 

Skin 

Other  or  not  specified  organs.  . 


Deaths 

from 
Cancer 

29 
180 

71 
184 

74 

19 
105 


Rate  per 

100,000 

Population 

2.8 
17.5 

6.9 
17.9 

7.2 

1.8 
10.2 


MALES 

Deaths  Rate  per 

from  100,000 

Cancer  Popiilation 

20  4.1 

67  13.8 

24  4.9 


10 
61 


2.1 
12.5 


FEMALES 

Deaths     Rate  per 

from         100,000 

Cancer  Population 


9 
113 

47 

184 

74 

9 

44 


1.7 
20.8 

8.7 
33.9 
13.6 

1.7 

8.0 


All  organs 662  64.3  182  37.4  480  88.4 

Source:     Annual  Reports  of  the  Health  Officer  of  the  City  of  Nashville,  Tenn. 


516 


APPENDIX  F  {PART  II) 

Table  93 

Mortality  from  Cancer  in  Newark,  N.  J. 

1859-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

(Calendar) 

Cancer 

Population 

1859 

67,895 

17 

25.0 

1891 

188,625 

98 

52.0 

1860 

71,941 

9 

12.5 

1892 

195,420 

117 

59.9 

1861 

75,035 

11 

14.7 

1893 

202,215 

101 

49.9 

1862 

1894 

209,010 

134 

64.1 

1863 

81,223 

12 

14.8 

1895 

215,806 

126 

58.4 

1864 
1865 

84,318 

11 

13.0 
15.8 

1891-1895 
1896 

1,011,076 

221,858 

576 
140 

57.0 

1859-1865 

380,412 

60 

63.1 

1897 

227,911 

122 

53.5 

1866 

90,942 

15 

16.5 

1898 

233,964 

130 

55.6 

1867 

94,471 

21 

22.2 

1899 

240,017 

135 

56.2 

1868 

1900 

246,070 

159 

64.6 

1869 
1870 

101,529 
105,059 

22 
20 

21.7 
19.0 

19.9 

1896-1900 
1901 

1,169,820 
253,513 

686 
171 

58.6 

1866-1870 

392,001 

78 

67.5 

1902 

260,957 

150 

57.5 

1871 

108,709 

23 

21.2 

1903 

268,401 

178 

66.3 

1872 

112,359 

31 

27.6 

1904 

275,845 

174 

63.1 

1873 

116,009 

42 

36.2 

1905 

283,289 

189 

66.7 

1874. 

119,659 
123,310 

46 
25 

38.4 
20.3 

28.8 

XO  1  T! 

1875 

1901-1905 
1906 

1,342,005 
296,125 

862 
209 

64.2 

1871-1875 

580,046 

167 

70.6 

1907 

308,961 

249 

80.6 

1876 

125,949 

48 

38.1 

1908 

321,797 

229 

71.2 

1877 

128,588 

50 

38.9 

1909 

334,633 

264 

78.9 

1878 

131,228 

70 

53.3 

1910 

347,469 

286 

82.3 

(Ending 

June  30) 

1879 

133,868 

57 

42.6 

1906-1910 

1,608,985 

1,237 

76.9 

1880 

136,508 

62 

45.4 

1911 

360,305 
373,141 

275 

76.3 

1876-1880 

656,141 

287 

43.7 

1912 

299 

80.1 

1913 

385,977 

303 

78.5 

1881 

139,804 

61 

43.6 

1882 

143,100 

58 

40.5 

Source: 

Annual  Reports  of  the 

Board  of 

1883 

146,396 

60 

41.0 

Health  of  the  State  of 

New  Jersey. 

1884 

149,692 

82 

54.8 

1885 

152,988 

80 

62.3 
46.6 

1881-1885 

731,980 

341 

1886 

158,756 

91 

57.3 

• 

1887 

164,524 

91 

55.3 

1888 

170,292 

94 

55.2  . 

1889 

176,061 

91 

51.7 

1890 

181,830 

85 

46.7 
53.1 

1886-1890 

851,463 

452 

517 


APPENDIX  F  {PART  II) 


Table  94 

Table  95 

Mortality  from  Cancer 

in 

Mortality  from  Cancer 

in 

Newark,  N,  J., 

by  Sex 

Vew  Haven, 

Conn. 

1902-1913 

1884)- 19 

13 

Deaths 

MALES 

Rate  per 

Year 

Population 

from 

100,000 

Deaths 

Rate  per 

Cancer 

Population 

Year 

Population            from 

100,000 

Cancer 

Population 

1880 

62,882 

37 

58.8 

1902 

128,647 

43 

33.4 

•     1881 

64,723 

43 

66.4 

1903 

132,458 

67 

50.6 

1882 

66,564 

31 

46.6 

1904 

136,269 

63 

46.2 

1883 

68,405 

40 

58.5 

1905 

140,080 

68 

48.5 

1884 
1885 

70,246 
72,088 

40 
30 

56.9 

41.6 

1902-1905 

537.454 

241 

44.8 

1881-1885 

342,026 

184 

53.8 

1906 

146,741 

64 

43.6 

1907 

153,403 

92 

60.0 

1886 

73,930 

48 

64.9 

1908 

160,065 

83 

51.9 

1887 

75,772 

48 

63.3 

1909 

166,727 

100 

60.0 

1888 

77,614 

40 

51.5 

1910 

173,389 

98 

56.5 

1889 

79,456 

39 

49.1 

1890 

81,298 

39 

48.0 

1906-1910 

800,325 

437 

54.6 

1886-1890 

388,070 

214 

55.1 

1911 

180,051 

98 

54.4 

1912 

186,713 

114 

61.1 

1891 

83,970 

35 

41.7 

1913 

193,375 

129 

66.7 

1892 

86,643 

53 

61.2 

1893 

89,316 

47 

52.6 

FE1L\LES 

1894 

91,989 

54 

58.7 

1895 

94,662 

60 

63.4 

1902 
1903 

132,310 
135,943 

107 

80.9 

111 

81.7 

1891-1895 

446,580 

249 

55.8 

1904 

139,576 

111 

79.5 

1905 

143,209 

121 

84.5 

1896 

97,335 

60 

61.6 

1897 

100,008 

64 

64.0 

1902-1905 

551,038 

450 

81.7 

1898 

102,681 

71 

69.1 

1899 

105,354 

74 

70.2 

1906 

149,384 

145 

97.1 

1900 

108,027 

71 

65.7 

1907 

155,558 

157 

100.9 

1908 

161,732 

146 

90.3 

1896-1900 

513,405 

340 

66.2 

1909 

167,906 

164 

97.7 

1901 

110,584 

98 

88.6 

1910 

174,080 

188 

108.0 

■    1902 

113,141 

87 

76.9 

1903 

115,699 

90 

77.8 

1906-1910 

808,060 

800 

98.9 

1904 

118,257 

81 

68.5 

1905 

120,815 

110 

91.0 

1911 

180,254 

177 

98.2 

1912 

186,428 

185 

99.2 

1901-1905 

578,496 

466 

80.6 

1913 

192,602 

174 

90.3 

1906 

123,373 

98 

79.4 

Source: 

Annual  Renort 

5  of  the  Board  of 

1907 

125,931 

109 

86.6 

Health  of  the  State  of  New  Jersey. 

1908 

128,489 

129 

100.4 

1909 

131,047 

119 

90.8 

1910 
1906-1910 

133,605 

122 

91.3 

642,445 

577 

89.8 

1911 

136,163 

112 

82.3 

1912 

138,721 

134 

96.6 

1913 

141,279 

127 

89.9 

Source :    Annual  Reports  of  the  Board  of 
Health  of  the  City  of  New  Haven,  Conn. 


518 


APPENDIX  F  {PART  II) 

Table  96 

Mortality  from  Cancer  in  New  Haven,  Conn.,  Males 

1880-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year             Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1880 

31,213 

8 

25.6 

1906  61,552 

1907  62,837 

35 
44 

56.9 
70.0 

1881 

32,135 

14 

43.6 

1908               64,123 

61 

95.1 

1882 

33,057 

10 

30.3 

1909               65,409 

49 

74.9 

1883 

33,979 

10 

29.4 

1910               66,695 

49 

73.5 

1884 

34,901 

11 

31.5 

1885 

35,823 

14 

39.1 
34.7 

1906-1910        320,616 
1911               67,981 

238 
37 

74.2 

1881-1885 

169,895 

59 

54.4 

1912               69,267 

62 

89.5 

1886 

36,745 

16 

43.5 

1913               70,553 

47 

66.6 

1887 

37,668 

15 

39.8 

1888 

38,591 

13 

33.7 

Source:    Annual  Reports  of  the  Board  of 

1889 

39,514 

11 

27.8 

Health  of  the  City  of  New  Haven 

Conn. 

1890 

40,437 

11 

27.2 
34.2 

1886-1890 

192,955 

66 

1891 

41,777 

11 

26.3 

1892 

43,117 

17 

39.4 

1893 

44,457 

18 

40.5 

1894 

45,797 

22 

48.0 

1895 

47,137 

16 

33.9 

37.8 

,;t 

1891-1895 

222,285 

84 

1896 

48,478 

23 

47.4 

1897 

49,819 

22 

44.2 

1898 

51,160 

23 

45.0 

1899 

52,501 

23 

43.8 

1900 

53,842 

32 

59.4 
48.1 

1896-1900 

255,800 

123 

1901 

55,127 

37 

67.1 

1902 

56,412 

27 

47.9 

1903 

57,697 

29 

50.3 

1904 

58,982 

24 

40.7 

1905 

60,267 

46 

76.3 
56.5 

1901-1905 

288,485 

163 

519 


APPENDIX  F  (PART  II) 

Table  97 
Mortality  from  Cancer  in  New  Haven,  Conn. 
1880-1913 


Females 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1880 

31.669 

29 

91.6 

1906 

61,821 

63 

101.9 

1907 

63,094 

65 

103.0 

1881 

32,588 

29 

89.0 

1908 

64,366 

68 

105.6 

1882 

33,507 

21 

62.7 

1909 

65,638 

70 

106.6 

1883 

34,426 

30 

87.1 

1910 

66,910 

73 

109.1 

1884 

35,345 

29 

82.0 

1885 

36,265 

16 

44.1 

72.6 

1906-1910 
1911 

321,829 
68,182 

339 

75 

105.3 

1881-1885 

172,131 

125 

110.0 

1912 

69,454 

72 

103.7 

1886 

37,185 

32 

86.1 

1913 

70,726 

80 

113.1 

1887 

38,104 

33 

86.6 

1888 

39,023 

27 

69.2 

Source: 

Annual  Reports  of  the  Board  of 

1889 

39,942 

28 

70.1 

Health  of  the  City  of  New  Haven, 

Conn. 

1890 

40,861 

28 

68.5 
75.9 

1886-1890 

195,115 

148 

1891 

42,193 

24 

56.9 

1892 

43,526 

36 

82.7 

. 

1893 

44,859 

29 

64.6 

1894 

46,192 

32 

69.3 

18^5 

47,525 

44 

92.6 
73.6 

1891-1895 

224,295 

165 

1896 

48,857 

37 

75.7 

1897 

50,189 

42 

83.7 

1898 

51,521 

48 

93.2 

1899 

52,853 

51 

96.5 

1900 

54,185 

39 

72.0 

84.2 

1896-1900 

257,605 

217 

1901 

55,457 

61 

110.0 

1902 

56,729 

60 

105.8 

1903 

58,002 

61 

105.2 

1904 

59,275 

57 

96.2 

1905 

60,548 

64 

105.6 
104.5 

1901-1905 

290,011 

303 

520 


APPENDIX  F  (PART  II) 

Table  98 

Mortality  from  Cancer  in  New  Orleans,  La. 

1871-1914 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1871 

193,753 

90 

46.5 

1901 

292,301 

206 

70.5 

1872 

196,117 

90 

45.9 

1902 

297,498 

214 

71.9 

1873 

198,509 

94 

47.4 

1903 

302,695 

235 

77.6 

1874 

200,931 

87 

43.3 

1904 

307,892 

252 

81.8 

1875 

203,382 

89 

43.8 
45.3 

1905 
1901-1905 

313,089 

261 

83.4 

1871-1875 

992,692 

450 

1,513,475 

1,168 

77.2 

1876 

205,863 

91 

44.2 

1906 

318,286 

247 

77.6 

1877 

208,375 

114 

54.7 

1907 

323,483 

269 

83.2 

1878 

210,917 

115 

54.5 

1908 

328,680 

270 

82.1 

1879 

214,490 

105 

49.0 

1909 

333,877 

280 

83.9 

1880 

216,090 

129 

59.7 
52.5 

1910 
1906-1910 

339,075 

285 

84.1 

1876-1880 

1,055,735 

554 

1,643,401 

1,351 

82.2 

1881 

218,571 

127 

58.1 

1911 

344,273 

277 

80.5 

1882 

221,045 

143 

64.7 

1912 

349,471 

328 

93.9 

1883 

223,565 

122 

54.6 

1913 

354,669 

330 

93.0 

1884 

226,114 

151 

66.8 

1914 

359,867 

349 

97.0 

1885 

228,692 

138 

60.3 

Source: 

1871-1899, 

Vital   Statistics   of 

1881-1885 

1,117,987 

681 

60.9 

New  Orleans,  La.,  Annual  Reports  of  the 
Board  of  Health  of  New  Orleans,  La. 

1886 

231,299 

158 

68.3 

1887 

233,936 

147 

62.8 

1888 

236,603 

143 

60.4 

1889 

239,300 

132 

55.2 

1890 

242,039 

190 

78.5 
65.1 

1886-1890 

1,183,177 

770 

1891 

246,545 

158 

64.1 

1892 

251,051 

168 

66.9 

1893 

255,557 

172 

67.3 

1894 

260,063 

174 

66.9 

1895 

264,569 

188 

71.1 
67.3 

1891-1895 

1,277,785 

860 

1896 

269,076 

139 

51.7 

1897 

273,583 

183 

66.9 

1898 

278,090 

185 

66.5 

1899 

282,597 

171 

60.5 

1900 

287,104 

185 

64.4 
62.1 

1896-1900 

1,390,450 

863 

521 


APPENDIX  F  (PART  II) 

Table  99 

Mortality  from  Cancer  in  New  Orleans,  La.,  White 

1877-1914 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1877 

153,132 

87 

56.8 

1901 

212,991 

146 

68.5 

1878 

154,877 

89 

57.5 

1902 

217,036 

166 

76.5 

1879 

156,622 

75 

47.9 

1903 

221,081 

174 

78.7 

1880 

158,367 

102 

64.4 

1904 

225,127 

186 

82.6 

56.7 

1905 

229,173 

196 

85.5 

1877-1880 

622,998 

353 

1901-1905 

1,105,408 

868 

78.5 

1881 

160,267 

88 

54.9 

1882 

162,168 

113 

69.7 

1906 

233,219 

183 

78.5 

1883 

1907 

237,265 

201 

84.7 

1884 

165,970 

113 

68.1 

1908 

241,311 

210 

87.0 

1885 

167,871 

102 

60.8 

1909 

245,357 

223 

90.9 

1910 

249,403 

216 

86.6 

1881-1885 

656,276 

416 

63.4 

1906-1910 

1,206,555 

1,033 

85.6 

1886 

169,772 

110 

64.8 

1887 

171,673 

104 

60.6 

1911 

253,449 

208 

82.1 

1888 

173,574 

109 

62.8 

1912 

257,495 

242 

94.0 

1889 

175,475 

111 

63.3 

1913 

261,541 

242 

92.5 

1890 

177,376 

142 

80.1 
66.4 

1914 
Source: 

265,587 
1877-1899, 

257 
Vital   Sta 

96.8 

1886-1890 

867,870 

576 

tistics   of 

New  Orleans,  La.,  Annual  Reports  of  the 

1891 

180,533 

118 

65.4 

Board  of  Health  of  New  Orleans 

La. 

1892 

183,690 

123 

67.0 

1893 

186,847 

128 

68.5 

1894 

190,004 

132 

69.5 

1895 

193,161 

134 

69.4 
68.0 

1891-1895 

934,235 

635 

1896 

196,318 

110 

56.0 

1897 

199,475 

145 

72.7 

1898 

202,632 

140 

69.1 

1899 

205,789 

131 

63.7 

1900 

208,946 

139 

66.5 
65.6 

1896-1900 

1,013,100 

665 

522 


APPENDIX  F  {PART  II) 

Table  100 

Mortality  from  Cancer  in  New  Orleans,  La.,  Colored 

1877-1914 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1877 

55,243 

27 

48.9 

1901 

79,310 

60 

75.7 

1878 

56,040 

26 

46.4 

1902 

80,462 

48 

59.7 

1879 

57,868 

30 

51.8 

1903 

81,614 

61 

74.7 

1880 

57,723 

27 

46.8 

1904 
1905 

82,765 
83,916 

66 
65 

79.7 

77.5 

1877-1880 

226,874 

110 

48.5 

1901-1905 

408,067 

300 

73.5 

1881 

58,304 

39 

66.9 

1882 

58,877 

30 

51.0 

1906 

85,067 

64 

75.2 

1883 

1907 

86,218 

68 

78.9 

1884 

60,144 

38 

63.2 

1908 

87,369 

60 

68.7 

1885 

60,821 

36 

59.2 

1909 
1910 

88,520 
89,672 

57 
69 

64.4 

76.9 

1881-1885 

238,146 

143 

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1906-1910 

436,846 

318 

72.8 

1886 

61,527 

48 

78.0 

1887 

62,263 

43 

69.1 

1911 

90,824 

69 

76.0 

1888 

63,029 

34 

53.9 

1912 

91,976 

86 

93.5 

1889 

63,825 

21 

32.9 

1913 

93,128 

88 

94.5 

1890 

64,663 

48 

74.2 
61.5 

1914 
Source: 

94,280 
1877-1899, 

92 
Vital   Sta 

97.6 

1886-1890 

315,307 

194 

tistics   of 

New  Orleans,  La.,  Annual  Reports  of  the 

1891 

66,012 

40 

60.6 

Board  of  Health  of  New  Orleans 

La. 

1892 

67,361 

45 

66.8 

1893 

68,710 

44 

64.0 

1894 

70,059 

42 

59.9 

1895 

71,408 

54 

225 

75.6 
65.5 

1891-1895 

343,550 

1896 

72,758 

29 

39.9 

1897 

74,108 

38 

51.3 

1898 

75,458 

45 

59.6 

1899 

76,808 

40 

52.1 

1900 

78,158 

46 

58.9 
52.5 

1896-1900 

377,290 

198 

523 


APPENDIX  F  {PART  II) 

Table  101 

Mortality  from  Cancer  in  New  Orleans,  La.,  by  Sex 

1901-1913 


MALES 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1901 
1902 
1903 
1904 
1905 

138,785 
141,502 
144,219 
146,936 
149,653 

89 
72 
79 
90 
93 

64.1 
50.9 
54.8 
61.3 
62.1 

1901-1905 

721,095 

423 

58.7 

1906 
1907 
1908 
1909 
1910 

152,370 
155,087 
157,804 
160,521 
163,239 

105 
100 
97 
114 
110 

68.9 
64.5 
61.5 
71.0 
67.4 

1906-1910 

789,021 

526 

66.7 

1911 
1912 
1913 

165,957 
168,675 
171,393 

FEMALES 

101 
158 
139 

60.9 
93.7 
81.1 

1901 
1902 
1903 
1904 
1905 

153,516 
155,996 
158,476 
160,956 
163,436 

117 
142 
156 
162 
168 

76.2 

91.0 

98.4 

100.6 

102.8 

1901-1905 

792,380 

745 

94.0 

1906 
1907 
1908 
1909 
1910 

165,916 
168,396 
170,876 
173,356 
175,836 

142 
169 
173 
166 
175 

85.6 

100.4 

101.2 

95.8 

99.5 

1906-1910 

854,380 

825 

96.6 

1911 
1912 
1913 

178,316 
180,796 
183,276 

176 
170 
191 

98.7 

94.0 

104.2 

Source:    Annual  Reports  of  the  Board  of  Health  of  New 
Orleans,  La. 


524 


APPENDIX  F  {PART  II) 

Table  102 
Mortality  from  Cancer  in  New  Orleans,  La.,  by  Organs  and  Parts 
according  to  Race,  1904-1913 


TOTAL 

Deaths  Rate  per 

Organ  or  Part                          from  100,000 

Cancer  Population 

Buccal  cavity 144  4.3 

Stomach  and  liver 802  24.2 

Peritoneum,  intestines,  rectum        214  6.5 

Female  generative  organs 690  20.8 

Breast 207  6.2 

Skin 30  0.9 

Other  or  not  specified  organs.  .        712  21.6 

Allorgans 2,799  84.5 


2,107 


86.6 


WHITE 

COLORED 

Deaths 

Rate  per 

Deaths 

Rate  per 

from 

100,000 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

120 

4.9 

24 

2.7 

616 

25.3 

186 

21.1 

161 

6.6 

53 

6.0 

444 

18.2 

246 

28.0 

149 

6.1 

58 

6.6 

26 

1.1 

4 

0.5 

591 

24.4 

121 

13.8 

692 


78.7 


Source:    Annual  Reports  of  the  Board  of  Health  of  the  City  of  New  Orleans,  La. 


Table  103 

Mortality  from  Cancer  in  New  Orleans,  La.,  by  Organs  and  Parts 

according  to  Sex  and  Race,  1904-1913 


Organ  or  Part 

Buccal  cavity 

Stomach  and  liver 

Peritoneum,  intestines,  rectum 

Skin 

Other  or  not  specified  organs. . 

All  organs 


Buccal  cavity 

Stomach  and  liver 

Peritoneum,  intestines,  rectum 

Female  generative  organs 

Breast 

Skin 

Other  or  not  specified  organs. . 


MALES 
TOTAL 

Deaths      Rate  per 


from 
Cancer 

111 

427 

100 

21 

448 


100,000 
Population 

7.0 

26.8 

6.3 

1.3 

28.2 


1,107  69.6 

FEMALES 


33 
375 
114 
690 
207 
9 
264 


All  organs 1,692 


1.9 
21.8 

6.6 
40.1 
12.0 

0.5 
15.4 

98.3 


WHITE 

Deaths       Rate  per 
100,000 
Population 

7.8 


from 
Cancer 


93 

327 
76 
18 

380 


894 


27.5 
6.4 
1.5 

32.1 

75.3 


COLORED 

Deaths      Rate  per 
100,000 
Population 

4.4 

24.7 

6.9 

0.7 

16.9 


from 
Cancer 

18 

100 

24 

3 

68 


213 


52.6 


1,213 


97.3 


27 

2.2 

6 

1.3 

289 

23.2 

86 

18.1 

85 

6.8 

29 

6.1 

444 

35.6 

246 

61.8 

149 

12.0 

58 

12.2 

8 

0.6 

1 

0.2 

211 

16.9 

53 

11.2 

479 


100.9 


Source:     Annual  Reports  of  the  Board  of  Health  of  the  City  of  New  Orleans,  La. 


525 


APPENDIX  F  (PART  II) 


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531 


APPENDIX  F  {PART  II) 

Table  106 

Mortality  from  Cancer  in  Greater  New  York 

1891-1914 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1891 

1,568,830 

902 

57.5 

1906 

4,235,007 

3,005 

71.0 

1892 

1,622,359 

996 

61.4 

1907 

4,367,976 

3,227 

73.9 

1893 

1,675,888 

993 

59.3 

1908 

4,500,945 

3,243 

72.1 

1894 

1,729,417 

1,022 

59.1 

1909 

4,633,914 

3,488 

75.3 

1895 

1,782,947 

1,030 

57.8 
59.0 

1910 
1906-1910 

4,766,883 

3,710 

77.8 

1891-1895 

8,379,441 

4,943 

22,504,725 

16,673 

74.1 

1896 

1,836,477 

1,141 

62.1 

1911 

4,899,852 

3,873 

79.0 

1897 

1,890,007 

1,217 

64.4 

1912 

5,032,821 

4,071 

80.9 

1898 

3,171,268 

2,006 

63.3 

1913 

5,165,790 

4,223 

81.7 

1899 

3,304,235 

2,136 

64.6 

1914 

5,298,759 

4,467 

84.3 

1900 

3,437,202 

2,291 

66.7 

Source : 

Annual  Reports  of  the  Board  of 

1896-1900 

13,639,189 

8,791 

64.5 

Health  of  the  City  of  N 

ew  York,  N.  Y. 

1901 

3,570,169 

2,463 

69.0 

1902 

3,703,136 

2,450 

66.2 

1903 

3,836,103 

2,608 

68.0 

1904 

3,969,071 

2,709 

68.3 

1905 

4,102,039 

2,875 

70.1 
68.3 

1901-1905 

19,180,518 

13,105 

Table  107 

Mortality  from  Cancer  in  Greater  New  York,  Males 

1891-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1891 

774,822 

318 

41.0 

1906 

2,111,770 

1,174 

55.6 

1892 

802,065 

356 

44.4 

1907 

2,179,448 

1,322 

60.7 

1893 

829,308 

383 

46.2 

1908 

2,247,126 

1,241 

55.2 

1894 

856,551 

362 

42.3 

1909 

2,314,804 

1,442 

62.3 

1895 

883,795 

391 

44.2 

43.7 

1910 
1906-1910 

2,382,482 

1,524 

64.0 

1891-1895 

4,146,541 

1,810 

11,235,630 

6,703 

59.7 

1896 

911,039 

449 

49.2    • 

1911 

2,450,160 

1,602 

65.4 

1897 

938,283 

474 

50.5 

1912 

2,517,838 

1,068 

66.2 

1898 

1,570,351 

773 

49.2 

1913 

2,585,516 

1,740 

67.3 

1899 

1,638,028 

785 

47.9 

1900 

1,705,705 

826 

48.4 

Source : 

Annual  Reports  of  the  Board  of 

Health  of  the  City  of  New  York 

N.Y. 

1896-1900 

6,763,406 

3,307 

48.9 

1901 

1,773,382 

935 

52.7 

1902 

1,841,059 

922 

50.1 

1903 

1,908,736 

1,014 

53.1 

1904 

1,976,414 

1,071 

54.2 

1905 

2,044,092 

1,134 

55.5 
53.2 

1901-1905 

9,543,683 

5,076 

532 


APPENDIX  F  (PART  II) 

Table  108 

Mortality  from  Cancer  in  Greater  New  York,  Females 

1891-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1891 

794,008 

584 

73.6 

1906 

2,123,237 

1,831 

86.2 

1892 

820,294 

640 

78.0 

1907 

2,188,528 

1,905 

87.0 

1893 

846,580 

610 

72.1 

1908 

2,253,819 

2,002 

88.8 

1894 

872,866 

660 

75.6 

1909 

2,319,110 

2,046 

88.2 

1895 

899,152 

639 

71.1 
74.0 

1910 
1906-1910 

2,384,401 

2,186 

91.7 

1891-1895 

4,232,900 

3,133 

11,269,095 

9,970 

88.5 

1896 

925,438 

692 

74.8 

1911 

2,449,692 

2,271 

92.7 

1897 

951,724 

743 

78.1 

1912 

2,514,983 

2,403 

95.5 

1898 

1,600,917 

1,233 

77.0 

1913 

2,580,274 

2,483 

96.2 

1899 

1,666,207 

1,351 

81.1 

1900 

1,731,497 

1,465 

84.6 

Source: 

Annual  Reports  of  the  Board  of 

Health  of  tne  <^ity  or  iNew  lorK, 

iM.  I. 

1896-1900 

6,875,783 

5,484 

79.8 

1901 

1,796,787 

1,528 

85.0 

1902 

1,862,077 

1,528 

82.1 

1903 

1,927,367 

1,594 

82.7 

1904 

1,992,657 

1,638 

82.2 

1905 

2,057,947 

1,741 

84.6 
83.3 

1901-1905 

9,636,835 

8,029 

Table  109 
Mortality  from  Cancer  in  Greater  New  York,  by  Age 
1893-1912 


Years 

All  Ages 

Population 

* 

Deaths 

from 

Cancer 

Rate  per 

100,000 

Population 

Years 

Ages  35-54 

Deaths 
Population          from 
Cancer 

Rate  per 

100,000 

Population 

1893-1897 
1898-1902 
1903-1907 
1908-1912 

8,914,736 
17,186,010 
20,510,196 
23,834,415 

5,403 
11,346 
14,424 
18,.S85 

60.6 
66.0 
70.3 
77.1 

1893-1897 
1898-1902 
1903-1907 
1908-1912 

2,006,992 
3,911,885 
4,752,536 
5,593,211 

2,334 
4,757 
5,833 
7,252 

116.3 
121.6 

122.7 
129.7 

Ages  Under 

35 

Ages  55  and  Over 

1893-1897 
1898-1902 
1903-1907 
1908-1912 

6,260,890 
11,961,215 
14,177,740 
16,394,286 

455 

845 

1,054 

1,247 

7.3 
7.1 
7.4 
7.6 

1893-1897 
1898-1902 
1903-1907 
1908-1912 

625,440 
1,285,750 
1,549,306 
1,812,910 

2,614 
5,744 
7,537 
9,886 

417.9 
446.7 
486.5 
545.3 

*Including 

unknown  ages. 

533 


APPENDIX  F  {PART  II) 

Table  110 

Mortality  from  Cancer  in  Greater  New  York,  by  Age,  Males 

1893-1912 


All  Ages 

* 

Ages  35-54 

Years 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Years 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1893-1897 
1898-1902 
1903-1907 
1908-1912 

4,418,976 

8,528,525 

10,220,460 

11,912,410 

2,059 
4,241 
5,715 

7,477 

46.6 
49.7 
55.9 
62.8 

1893-1897 
1898-1902 
1903-1907 
1908-1912 

1,047,346 
2,037,950 
2,465,050 
2,892,156 

811 
1,589 
2,056 
2,569 

77.4 
78.0 
83.4 
88.8 

Ages  Under  35 

Ages  55  and  Over 

1893-1897 
1898-1902 
1903-1907 
1908-1912 

3,062,165 
5,865,080 
6,997,730 
8,130,386 

174 

328 
444 
501 

5.7 
5.6 
6.3 
6.2 

1893-1897 
1898-1902 
1903-1907 
1908-1912 

296,285 
607,030 
735,455 
863,890 

1,074 
2,324 
3,215 

4,407 

362.5 
382.8 
437.1 
510.1 

*Including  unknown  ages. 

Table  111 
Mortality  from  Cancer  in  Greater  New  York,  by  Age,  Females 

1893-1912 


Years 

All  Ages 
Population 

* 

Deaths 

from 
Cancer 

Rate  per 

100,000 

Population 

Years 

Ages  35-54 

Deaths 
Population            from 
Cancer 

Rate  per 

100,000 

Population 

1893-1897 
1898-1902 
1903-1907 
1908-1912 

4,495,760 

8,657,485 

10,289,736 

11,922,005 

3,344 

7,105 

8,709 

10,908 

74.4 
82.1 
84.6 
91.5 

1893-1897 
1898-1902 
1903-1907 
1908-1912 

959,646 
1,873,935 
2,287,486 
2,701,055 

1,523 
3,168 

3,777 
4,683 

158.7 
169.1 
165.1 
173.4 

Ages  Under  35 

Ages  55  and  Over 

1893-1897 
1898-1902 
1903-1907 
1908-1912 

3,198,725 
6,096,135 
7,180,010 
8,263,900 

281 
517 
610 

746 

8.8 
8.5 
8.5 
9.0 

1893-1897 
1898-1902 
1903-1907 
1908-1912 

329,155 
678,720 
813,851 
949,020 

1,540 
3,420 
4,322 
5,479 

467.9 
503.9 
531.1 
577.3 

*Including 

unknown  ages 

APPENDIX  F  {PART  II) 


Table  112 

Table  113 

Mortality  from  Cancer  of  th 

e  Buccal 

Mortality  from  Cancer  of  Stomach 

Cavity,  according  to  Sex 

and 

Liver,  according  to 

Sex 

Greater  New  York 

Greater  New  York 

1903-191 

2 

1903-19 

12 

TOTAL 

TOTAL 

Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1903 

3,836,103 

127 

3.3 

1903 

3,836,103 

1,043 

27.2 

1904 

3,969,071 

88 

2.2 

1904 

3,969,071 

1,141 

28.7 

1905 

4,102,039 

108 

2.6 

1905 

4,102,039 

1,135 

27.7 

1906 

4,235,007 

113 

2.7 

1906 

4,235,007 

1,235 

29.2 

1907 

4,367,976 

128 

2.9 

1907 

4,367,976 

1,281 

29.3 

1908 

4,500,945 

111 

2.5 

1908 

4,500,945 

1,316 

29.2 

1909 

4,633,914 

131 

2.8 

1909 

4,633,914 

1,421 

30.7 

1910 

4,766,883 

140 

2.9 

1910 

4,766,883 

1,433 

30.1 

1911 

4,899,852 

131 

2.7 

1911 

4,899,852 

1,543 

31.5 

1912 

5,032,821 

153 

3.0 

2.8 

1912 
1903-1912 

5,032,821 

1,608 

32.0 

1903-1912 

44,344,611 

1,230 

44,344,611 

13,156 

29.7 

MALES 

MALES 

1903 

1,908,736 

101 

5.3 

1903 

1,908,736 

538 

28.2 

1904 

1,976,414 

67 

3.4 

1904 

1,976,414 

562 

28.4 

1905 

2,044,092 

88 

4.3 

1905 

2,044,092 

568 

27.8 

1906 

2,111,770 

93 

4.4 

1906 

2,111,770 

591 

28.0 

1907 

2,179,448 

103 

4.7 

1907 

2,179,448 

667 

30.6 

1908 

2,247,126 

95 

4.2 

1908 

2,247,126 

626 

27.9 

1909 

2,314,804 

116 

5.0 

1909 

2,314,804 

753 

32.5 

1910 

2,382,482 

119 

5.0 

1910 

2,382,482 

713 

29.9 

1911 

2,450,160 

109 

4.4 

1911 

2,450,160 

791 

32.3 

1912 

2,517,838 

123 

4.9 

4.6 

1912 
1903-1912 

2,517,838 

801 

31.8 

1903-1912 

22,132,870 

1,014 

22,132,870 

6,610 

29.9 

FEMALES 

FEMALES 

1903 

1.927,367 

26 

1.3 

1903 

1,927,367 

505 

26.2 

1904 

1,992,657 

21 

1.1 

1904 

1,992,657 

579 

29.1 

1905 

2,057,947 

20 

1.0 

1905 

2,057,947 

567 

27.6 

1906 

2,123,237 

20 

0.9 

1906 

2,123,237 

644 

30.3 

1907 

2,188,528 

25 

1.1 

1907 

2,188,528 

614 

28.1 

1908 

2,253,819 

16 

0.7 

1908 

2,253,819 

690 

30.6 

1909 

2,319,110 

15 

0.6 

1909 

2,319,110 

668 

28.8 

1910 

2,384,401 

21 

0.9 

1910 

2,384,401 

720 

30.2 

1911 

2,449,692 

22 

0.9 

1911 

2,449,692 

752 

30.7 

1912 

2,514,983 

30 

1.2 

1.0 

1912 
1903-1912 

2,514,983 

807 

32.1 

1903-1912 

22,211,741 

216 

22,211,741 

6,546 

29.5 

535 


APPENDIX  F  {PART  II) 

Table  114 

Mortality  from  Cancer  of  Peritoneum,  Intestines,  Rectum 

according  to  Sex,  Greater  New  York 

1903-1912 


TOTAL 

MALES 

Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1903 

3,836,103 

342 

8.9 

1903 

1,908,736 

146 

7.6 

1904 

3,969,071 

355 

8.9 

1904 

1,976,414 

164 

8.3 

1905 

4,102,039 

399 

9.7 

1905 

2,044,092 

179 

8.8 

1906 

4,235,007 

427 

10.1 

1906 

2,111,770 

183 

8.7 

1907 

4,367,976 

467 

10.7 

1907 

2,179,448 

211 

9.7 

1908 

4,500,945 

461 

10.2 

1908 

2,247,126 

183 

8.1 

1909 

4,633,914 

459 

9.9 

1909 

2,314,804 

223 

9.6 

1910 

4,766,883 

602 

12.6 

1910 

2,382,482 

285 

12.0 

1911 

4,899,852 

544 

11.1 

1911 

2,450,160 

257 

10.5 

1912 

5,032,821 

608 

12.1 
10.5 

1912 
1903-1912 

2,517,838 

279 

11.1 

1903-1912  44,344,611 

4,664 

22,132,870 

2,110 

9.5 

FEMALES 

Deaths 

Year 

Population 

from 
Cancer 

1903 

1,927,367 

196 

1904 

1,992,657 

191 

1905 

2,057,947 

220 

1906 

2,123,237 

244 

1907 

2,188,528 

256 

1908 

2,253,819 

278 

1909 

2,319,110 

236 

1910 

2,384,401 

317 

1911 

2,449,692 

287 

1912 

2,514,983 

329 

1903-1912  22,211,741         2,554 


Rate  per 

100,000 

Population 

10.2 
9.6 
10.7 
11.5 
11.7 
12.3 
10.2 
13.3 
11.7 
13.1 

11.5 


Table 

115 

Table  116 

Mortality  from  Cancer  of  Female 

Mortality  from  Cancer  of  Female 

Generative 

Organs 

Breast 

Greater  New  York,  1903- 

1912 

Rate  per 

Grej 

iter  New  Yor 

k,  1903 

Deaths 

-1912 

Deaths 

Rate  per 

Female 

irom 

100,000 

Female 

from 

100,000 

Year 

Population 

Cancer 

Population 

Year 

Population 

Cancer 

Population 

1903 

1,927,367 

424 

22.0 

1903 

1,927,307 

253 

13.1 

1904 

1,992,657 

419 

21.0 

1904 

1,992,657 

239 

12.0 

1905 

2,057,947 

478 

23.2 

1905 

2,057,947 

265 

12.9 

1906 

2,123,237 

447 

21.1 

1906 

2,123,237 

268 

12.6 

1907 

2,188,528 

494 

22.6 

1907 

2,188,528 

283 

12.9 

1908 

2,253,819 

543 

24.1 

1908 

2,253,819 

267 

11.8 

1909 

2,319,110 

557 

24.0 

1909 

2,319,110 

314 

13.5 

1910 

2,384,401 

553 

23.2 

1910 

2,384,401 

348 

14.6 

1911 

2,449,692 

551 

22.5 

1911 

2,449,692 

361 

14.7 

1912 

2,514,983 

580 

23.1 

22.7 

1912 
1903-1912 

2,514,983 

346 

13.8 

1903-1912  22,211,741 

5,046 

22,211,741 

2,944 

13.3 

536 


APPENDIX  F  {PART  II) 


Table  117 

Mortality  from  Cancer  of  the  Skin 

according  to  Sex 

Greater  New  York,  1903-1912 


Table  118 
Mortality  from  Cancer  of  Other  or 

Not  Specified  Organs,  according 
to  Sex,  Greater  New  York,  1903-1912 


- 

TOTAL 

TOTAL 

Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1903 

3,836,103 

78 

2.0 

1903 

3,836,103 

341 

8.9 

1904 

3,969,071 

74 

1.9 

1904 

3,969,071 

393 

9.9 

1905 

4,102,039 

83 

2.0 

1905 

4,102,039 

407 

9.9 

1906 

4,235,007 

73 

1.7 

1906 

4,235,007 

442 

10.4 

1907 

4,367,976 

72 

1.6 

1907 

4,367,976 

502 

11.5 

1908 

4,500,945 

63 

1.4 

1908 

4,500,945 

482 

10.7 

1909 

4,633,914 

74 

1.6 

1909 

4,633,914 

532 

11.5 

1910 

4,766,883 

74 

1.6 

1910 

4,766,883 

560 

11.7 

1911 

4,899,852 

64 

1.3 

1911 

4,899,852 

679 

13.9 

1912 

5,032,821 

70 

1.4 
1.6 

1912 
1903-1912 

5,032,821 

706 

14.0 

1903-1912  44,344,611 

725 

44,344,611 

5,044 

11.4 

MALES 

MALES 

1903 

1,908,736 

51 

2.7 

1903 

1,908,736 

178 

9.3 

1904 

1,976,414 

45 

2.3 

1904 

1,976,414 

233 

11.8 

1905 

2,044,092 

65 

3.2 

1905 

2,044,092 

234 

11.4 

1906 

2,111,770 

52 

2.5 

1906 

2,111,770 

255 

12.1 

1907 

2,179,448 

38 

1.7 

1907 

2,179,448 

303 

13.9 

1908 

2,247,126 

34 

1.5 

1908 

2,247,126 

303 

13.5 

1909 

2,314,804 

43 

1.9 

1909 

2,314,804 

307 

13.3 

1910 

2,382,482 

49 

2.1 

1910 

2,382,482 

358 

15.0 

1911 

2,450,160 

42 

1.7 

1911 

2,450,160 

403 

16.4 

1912 

2,517,838 

43 

462 

1.7 
2.1 

1912 
1903-1912 

2,517,838 

422 
2,996 

16.8 

1903-1912  22,132,870 

22,132,870 

13.5 

FEMALES 

FEMALES 

1903 

1,927,367 

27 

1.4 

1903 

1,927,367 

163 

8.5 

1904 

1,992,657 

29 

1.5 

1904 

1,992,657 

160 

8.0 

1905 

2,057,947 

18 

•  0.9 

1905 

2,057,947 

173 

8.4 

1906 

2,123,237 

21 

1.0 

1906 

2,123,237 

187 

8.8 

1907 

2,188,528 

34 

1.6 

1907 

2,188,528 

199 

9.1 

1908 

2,253,819 

29 

1.3 

1908 

2,253,819 

179 

7.9 

1909 

2,319,110 

31 

1.3 

1909 

2,319,110 

225 

9.7 

1910 

2,384,401 

25 

1.0 

1910 

2,384,401 

202 

8.5 

1911 

2,449,692 

22 

0.9 

1911 

2,449,692 

276 

11.3 

1912 

2,514,983 

27 

1.1 
1.2 

1912 
1903-1912 

2,514,983 

284 

11.3 

1903-1912 

22,211,741 

263 

22,211,741 

2,048 

9.2 

537 


APPENDIX  F  {PART  II) 

Table  119 

Mortality  from  Cancer  in  Greater  New  York,  by  Organs  and  Parts 

1903-1907  Compared  with  1908-1912 


1903-1907 

Deaths  Rate  per 

from  100,000 

Organ  or  Part                                   Cancer  Population 

Buccal  cavity 564  2.7 

Stomach  and  liver 5,835  28.4 

Peritoneum,  intestines  and  rectum..  .      1,990  9.7 

Female  generative  organs 2,262  11.0 

Femalebreast 1,308  6.4 

Skin 380  1.9 

Other  or  not  specified  organs 2,085  10.2 

Allorgans 14,424  70.3 


1908-1912 

Deaths 

Rate  per 

from 

100,000 

Percentage 

Cancer 

Population 

of  Increase 

666 

2.8 

3.7 

7,321 

30.7 

8.1 

2,674 

11.2 

15.4 

2,784 

11.7 

6.4 

1,636 

6.9 

7.8 

345 

1.4 

-26.3 

2,959 

12.4 

21.6 

18,385         77.1 


9.7 


Table  120 

Mortality  from  Cancer  in  Greater  New  York,  by  Organs  and  Parts 

according  to  Sex,  1903-1907  Compared  with  1908-1912 


MALES 
1903-1907 
Deaths      Rate  per 
from        100,000 
Organ  or  Part  Cancer   Population 

Buccal  cavity 452  4.4 

Stomach  and  hver 2,926  28.6 

Peritoneum,  intestines  and  rectum .  .  883  8.6 

Skin 251  2.5 

Other  or  not  specified  organs 1,203  11.8 

Allorgans 5,715         55.9 

FEMALES 

Buccal  cavity 112  1.1 

Stomach  and  liver 2,909  28.2 

Peritoneum,  intestines  and  rectum .  .  1,107  10.8 

Female  generative  organs 2,262  22.0 

Breast 1,308  12.7 

Skin 129  1.3 

Other  or  not  specified  organs 882  8.3 

Allorgans 8,709         84.4 


1908-1912 
Deaths      Rate  per 
from         100,000 
Cancer    Population 


562 
3,684 
1,227 

211 
1,793 


4.7 
30.9 
10.3 

1.8 
15.1 


10,908 


91.5 


Percentage 
of  Increase 


8.0 

19.8 

-28.0 

28.0 


7,477 

62.8 

12.3 

104 

0.9 

-18.2 

3,637 

30.5 

8.2 

1,447 

12.1 

12.0 

2,784 

23.4 

6.4 

1,636 

13.7 

7.9 

134 

1.1 

-15.4 

1,166 

9.8 

18.1 

8.4 


538 


APPENDIX  F  (PART  II) 

Table  121 
Mortality  from  Cancer  in  Greater  New  York,  by  Boroughs,  according  to  Sex 

1903-1912 


TOTAL 

Deaths  Rate  per 

Boroughs                                                                               Population  from  100,000 

Cancer  Population 

Manhattan 22,111,795  17,854  80.7 

Bronx 3,733,606  2,546  68.2 

Brooklyn 15,174,082  10,273  67.7 

Queens 2,512,791  1,429  56.9 

Richmond 812,311  707  87.0 

Greater  New  York 44,344,585  32,809  74.0 

MALES 

Manhattan 11,045,590  7,555  68.4 

Bronx 1,882,781  970  51.5 

Brooklyn 7,507,760  3,807  50.7 

Queens 1,275,400  516  40.5 

Richmond 421,320  344  81.6 

Greater  New  York 22,132,851  13,192  59.6 

FEMALES 

Manhattan 11,066,205  10,299  93.1 

Bronx 1,850,825  1,576  85.2 

Brooklyn 7,666,322  6,466  84.3 

Queens 1,237,391  913  73.8 

Richmond 390,991  363  92.8 

Greater  New  York 22,211,734  19,617  88.3 

Source:     For  Tables  109  to  121,  Annual  Reports  of  the  Board  of  Health  of  the  City 
of  New  York,  N.  Y. 


539 


APPENDIX  F  {PART  II) 

Table  122 
Mortality  from  Cancer  in  the  City  of  New  York  (Manhattan  and  Bronx) 

1871-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1871 

968,692 

335 

34.6 

1896 

1,836,477 

1,141 

62.1 

1872 

995,092 

392 

39.4 

1897 

1,890,007 

1,217 

64.4 

1873 

1,021,492 

425 

41.6 

1898 

1,943,538 

1,260 

64.8 

1874 

1,047,893 

416 

39.7 

1899 

1,997,069 

1,321 

66.1 

1875 

1,074,294 

424 

39.5 
39.0 

1900 
1896-1900 

2,050,600 

1,473 

71.8 

1871-1875 

5,107,463 

1,992 

9,717,691 

6,412 

66.0 

1876 

1,100,695 

459 

41.7 

1901 

2,121,791 

1,575 

74.2 

1877 

1,127,096 

495 

43.9 

1902 

2,192,982 

1,536 

70.0 

1878 

1,153,497 

570 

49.4 

1903 

2,264,174 

1,684 

74.4 

1879 

1  179,898 

572 

48.5 

1904 

2,335,366 

1,740 

74.5 

1880 

1,206,299 

659 

54.6 

47.8 

1905 
1901-1905 

2,406,558 

1,834 
8,369 

76.2 

1876-1880 

5,767,485 

2,755 

11,320,871 

73.9 

1881 

1,237,198 

706 

57.1 

1906 

2,477,750 

1,856 

74.9 

1882 

1,268,097 

732 

57.7 

1907 

2,548,943 

2,032 

79.7 

1883 

1,298,996 

678 

52.2 

1908 

2,620,136 

2,020 

77.1 

1884 

1,329,896 

731 

55.0 

1909 

2,691,329 

2,123 

78.9 

1885 

1,360,796 

754 

55.4 
55.4 

1910 
1906-1910 

2,762,522 

2,238 

81.0 

1881-1885 

6,494,983 

3,601 

13,100,680 

10,269 

78.4 

1886 

1,391,697 

779 

56.0 

1911 

2,833,714 

2,376 

83.8 

1887 

1,422,598 

832 

58.5 

1912 

2,904,907 

2,497 

86.0 

1888 

1,453,499 

870 

59.9 

1913 

2,976,099 

2,532 

85.1 

1889 

1,484,400 

848 

57.1 

1890 

1,515,301 

954 

63.0 

Source: 

Annual  Reports  of  the  Board  of 

Health  of  tVi<»  Ti+v  nf 

S^ew  York 

N.  Y. 

1886-1890 

7,267,495 

4,283 

58.9 

1891 

1,568,830 

902 

57.5 

1892 

1,622,359 

996 

61.4 

1893 

1,675,888 

993 

59.3 

1894 

1,729,417 

1,022 

59.1 

1895 

1,782,947 

1,030 

57.8 
59.0 

1891-1895 

8,379,441 

4,943 

540 


APPENDIX  F  {PART  II) 

Table  123 
Mortality  from  Cancer  in  the  City  of  New  York  (Manhattan  and  Bronx) 

Males,  1871-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1871 

470,456 

93 

19.8 

1896 

911,039 

449 

49.3 

1872 

483,795 

114 

23.6 

1897 

938,283 

474 

50.5 

1873 

497,134 

138 

27.8 

1898 

965,527 

497 

51.5 

1874 

510,474 

124 

24.3 

1899 

992,771 

509 

51.3 

1875 

523,814 

147 

28.1 
24.8 

1900 
1896-1900 

1,020,015 

558 

54.7 

1871-1875 

2,485,673 

616 

4,827,635 

2,487 

51.5 

1876 

537,154 

152 

28.3 

1901 

1,056,391 

629 

59.5 

1877 

550,494 

153 

27.8 

1902 

1,092,767 

590 

54.0 

1878 

563,834 

182 

32.3 

1903 

1,129,143 

655 

58.0 

1879 

577,174 

193 

33.4 

1904 

1,165,519 

710 

60.9 

1880 

590,514 

219 

37.1 
31.9 

1905 
1901-1905 

1,201,895 

768 

63.9 

1876-1880 

2,819,170 

899 

5,645,715 

3,352 

59.4 

1881 

606,220 

244 

40.2 

1906 

1,238,271 

766 

61.9 

1882 

621,926 

265 

42.6 

1907 

1,274,648 

839 

65.8 

1883 

637,632 

221 

34.7 

1908 

1,311,025 

827 

63.1 

1884 

653,338 

263 

40.3 

1909 

1,347,402 

920 

68.3 

1885 

669,044 

228 

34.1 
38.3 

1910 
1906-1910 

1,383,779 

982 

71.0 

1881-1885 

3,188,160 

1,221 

6,555,125 

4,334 

66.1 

1886 

684,751 

257 

37.5 

1911 

1,420,155 

1,008 

71.0 

1887 

700,458 

278 

39.7 

1912 

1,456,532 

1,050 

72.1 

1888 

716,165 

284 

39.7 

1913 

1,492,908 

1,072 

71.8 

1889 

731,872 

276 

37.7 

1890 

747,579 

356 

47.6 

Source: 

Annual  Reports  of  the  Board  of 

Health  of  the  City  of  N 

ew  York 

N.  Y. 

1886-1890 

3,580,825 

1,451 

40.5 

1891 

774,822 

318 

41.0 

1892 

802,065 

356 

44.4 

1893 

829,308 

383 

46.2 

1894 

856,551 

362 

42.3 

1895 

883,795 

391 

44.2 
43.7 

1891-1895 

4,146,541 

1,810 

541 


APPENDIX  F  {PART  II) 

Table  124 
Mortality  from  Cancer  in  the  City  of  New  York  (Manhattan  and  Bronx) 

Females,  1871-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1871 

498,236 

242 

48.6 

1896 

925,438 

692 

74.8 

1872 

511,297 

278 

54.4 

1897 

951,724 

743 

78.1 

1873 

524,358 

287 

54.7 

1898 

978,011 

763 

78.0 

1874 

537,419 

292 

54.3 

1899 

1,004,298 

812 

80.9 

1875 

550,480 
2,621,790 

277 

50.3 
52.5 

1900 
1896-1900 

1,030,585 

915 

88.8 

1871-1875 

1,376 

4,890,056 

3,925 

80.3 

1876 

563,541 

307 

54.5 

1877 

576,602 

342 

59.3 

1901 

1,065,400 

946 

88.8 

1878 

589,663 

388 

65.8 

1902 

1,100,215 

946 

86.0 

1879 

602,724 

379 

62.9 

1903 

1,135,031 

1,029 

90.7 

1880 

615,785 

2,948,315 

630,978 

646,171 

440 

71.5 
63.0 

73.2 
72.3 

1904 
1905 

1901-1905 

1,169,847 
1,204,663 

1,030 
1,066 

88.0 

1876-1880 

1,856 
462 
467 

88.5 

1881 
1882 

5,675,156 

5,017 

88.4 

1883 
1884 
1885 

661,364 
676,558 
691,752 

457 
468 
526 

69.1 
69.2 
76.0 

1906 
1907 
1908 

1,239,479 
1,274,295 
1,309,111 

1,090 
1,193 
1,193 

87.9 
93.6 
91.1 

1881-1885 

3,306,823 

2,380 

72.0 

1909 

1,343,927 

1,203 

89.5 

1886 

706,946 

522 

73.8 

1910 

1,378,743 

1,256 

91.1 

1887 

722,140 

554 

76.7 

1888 

737,334 

586 

79.5 

1906-1910 

6,545,555 

5,935 

90.7 

1889 

752,528 

572 

76.0 

1890 

767,722 

598 

77.9 

1911 

1,413,559 

1,368 

96.8 

1912 

1,448,375  • 

1,447 

99.9 

1886-1890 

3,686,670 

2,832 

76.8 

1913 

1,483,191 

1,460 

98.4 

1891 

794,008 

584 

73.6 

1892 

820,294 

640 

78.0 

Source: 

Annual  Reports  of  the 

Board  of 

1893 

846,580 

610 

72.1 

Health  of  the  City  of  New  York 

N.  Y. 

1894 

872,866 

660 

75.6 

1895 

899,152 

639 

71.1 

1891-1895 

4,232,900 

3,133 

74.0 

Table  125 
Mortality  from  Cancer  in  Omaha,  Neb.,  1900-1913 


Year 

1900 

1901 
1902 
1903 
1904 
1905 

Population 

102,555 

104,709 
106,863 
109,017 
111,171 
113,325 

Deaths 
from 
Cancer 

45 

60 
51 

54 
73 
87 

Rate  per 

100,000 

Population 

43.9 

57.3 

47.7 
49.5 
65.7 
76.8 

59.6 

Year 

1906 
1907 
1908 
1909 
1910 

1906-1910 

1911 
1912 
1913 
Source: 
tistics. 

Population 

115,479 
117,633 
119,787 
121,941 
124,096 

Deaths 
from 
Cancer 

93 
108 

97 
101 
114 

Rate  per 

100,000 

Population 

80.5 
91.8 
81.0 
82.8 
91.9 

598,936            513 

126,250            112 

128,404            114 

130,558            129 

United  States   Mort 

85.7 

1901-1905 

545,085 

325 

88.7 
88.8 
98.8 
ality  Sta- 

APPENDIX  F  {PART  II) 

Table  126 

Mortality  from  Cancer  in  Philadelphia,  Pa. 

1861-1914 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1861 

576,378 

189 

32.8 

1891 

1,071,637 

572 

53.4 

1862 

587,227 

181 

30.8 

1892 

1,096,310 

571 

52.1 

1863 

598,076 

190 

31.8 

1893 

1,120,983 

614 

'54.8 

1864 

608,925 

180 

29.6 

1894 

1,145,656 

589 

51.4 

1895 

1,170,329 

682 

58.3 

1861-1864 

2,370,606 

740 

31.2 

1891-1895 

5,604,915 

3,028 

54.0 

1866 

630,623 

203 

32.2 

1867 

641,472 

200 

31.2 

1896 

1,195,002 

676 

56.6 

1868 

652,322 

236 

36.2 

1897 

1,219,675 

698 

57.2 

1869 

663,172 

232 

35.0 

1898 

1,244,349 

671 

53.9 

1870 

674,022 

261 

38.7 

1899 

1,269,023 

777 

61.2 

1900 

1,293,697 

810 

62.6 

1866-1870 

3,261,611 

1,132 

34.7 

1896-1900 

6,221,746 

3,632 

58.4 

1871 

691,336 

280 

40.5 

1872 

708,650 

316 

44.6 

1901 

1,319,227 

775 

58.8 

1873 

725,964 

268 

36.9 

1902 

1,344,757 

860 

64.0 

1874 

743,278 

308 

41.4 

1903 

1,370,288 

965 

70.4 

1875 

760,593 

318 

41.8 

1904 

1,395,819 

1,037 

74.3 

1905 

1,421,350 

1,037 

73.0 

1871-1875 

3,629,821 

1,490 

41.0 



1901-1905 

6,851,441 

4,674 

68.2 

1876 

777,908 

305 

39.2 

1877 

795,223 

327 

41.1 

1906 

1,446,881 

1,125 

77.8 

1878 

812,538 

380 

46.8 

1907 

1,472,412 

1,164 

79.1 

1879 

829,854 

362 

43.6 

1908 

1,497,944 

1,235 

82.4 

1880 

847,170 

368 

43.4 

1909 

1,523,476 

1,306 

85.7 

1910 

1,549,008 

1,304 

84.2 

1876-1880 

4,062,693 

1,742 

42.9 

1906-1910 

7,489,721 

6,134 

81.9 

1881 

867,148 

417 

48.1 

1882 

887,126 

429 

48.4 

1911 

1,574,540 

1,354 

86.0 

1883 

907,104 

405 

44.6 

1912 

1,600,072 

1,411 

88.2 

1884 

927,084 

476 

51.3 

1913 

1,625,604 

1,551 

95.4 

1885 

947,064 

487 

51.4 

48.8 

1914 
Source: 

1,651,136         1,534 
Annual  Reports  of  the 

92.9 

1881-1885 

4,535,526 

2,214 

bureau  of 

Health  of  the  City  of  Philadelphia,  Pa. 

1886 

967,044 

457 

47.3 

1887 

987,024 

500 

50.7 

1888 

1,007,004 

448 

44.5 

1889 

1,026,984 

532 

51.8 

1890 

1,046,964 

538 
2,475 

51.4 
49.2 

1886-1890 

5,035,020 

543 


APPENDIX  F  (PART  II) 

Table  127 

Mortality  from  Cancer  in  Philadelphia,  Pa.,  Males 

1861-1914 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1861 

274,437 

64 

23.3 

1891 

523,458 

186 

35.5 

1862 

279,541 

59 

21.1 

1892 

535,794 

183 

34.2 

1863 

284,645 

52 

18.3 

1893 

548,130 

183 

33.4 

1864 

289,749 

49 

16.9 

1894 

560,466 

188 

33.5 

1895 

572,802 

211 

36.8 

1861-1864 

1,128,372 

224 

19.9 

1891-1895 

2,740,650 

951 

34.7 

1866 

299,959 

55 

18.3 

1867 

305,064 

50 

16.4 

1896 

585,138 

242 

41.4 

1868 

310,169 

75 

24.2 

1897 

597,474 

244 

40.8 

1869 

315,274 

65 

20.6 

1898 

609,811 

205 

33.6 

1870 

320,379 

77 

24.0 

1899 

622,148 

252 

40.5 

1900 

634,485 

298 

47.0 

1866-1870 

1,550,845 

322 

20.8 

1896-1900 

3,049,056 

1,241 

40.7 

1871 

328,938 

84 

25.5 

1872 

337,497 

108 

32.0 

1901 

647,082 

288 

44.5 

1873 

346,056 

77 

22.3 

1902 

659,679 

295 

44.7 

1874 

354,615 

93 

26.2 

1903 

672,277 

341 

50.7 

1875 

363,175 

100 

27.5 

1904 

684,875 

364 

53.1 

1905 

697,473 

369 

52.9 

1871-1875 

1,730,281 

462 

26.7 

1901-1905 

3,361,386 

1,657 

49.3 

1876 

371,735 

102 

27.4 

1877 

380,295 

108 

28.4 

1906 

710,071 

392 

55.2 

1878 

388,855 

120 

30.9 

1907 

722,669 

432 

59.8 

1879 

397,415 

105 

26.4 

1908 

735,267 

470 

63.9 

1880 

405,975 

100 

24.6 

1909 

747,865 

519 

69.4 

27.5 

1910 

760,463 

487 

64.0 

1876-1880 

1,944,275 

535 

1906-1910 

3,676,335 

2,300 

62.6 

1881 

416,489 

127 

30.5 

1882 

427,003 

145 

34.0 

1911 

773,061 

520 

67.3 

1883 

437,517 

132 

30.2 

1912 

785,659 

544 

69.2 

1884 

448,032 

134 

29.9 

1913 

798,257 

612 

76.7 

1885 

458,547 

143 

31.2 
31.1 

1914 

Source : 

810,855            588 
Annual  Reports  of  the 

72.5 

1881-1885 

2,187,588 

681 

Bureau  of 

Health  of  the  City,  of  Philadelphia,  Pa. 

1886 

469,062 

118 

25.2 

1887 

479,577 

140 

29.2 

1888 

490,092 

126 

25.7 

1889 

500,607 

175 

35.0 

1890 

511,122 

171 

33.5 
29.8 

1886-1890 

2,450,460 

730 

544 


APPENDIX  F  {PART  II) 

Table  128 
Mortality  from  Cancer  in  Philadelphia,  Pa. 
1861-1914 


Females 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1861 

301,941 

125 

41.4 

1891 

548,179 

386 

70.4 

1862 

307,686 

122 

39.7 

1892 

560,516 

388 

69.2 

1863 

313,431 

138 

44.0 

1893 

572,853 

431 

75.2 

1864 

319,176 

131 

41.0 

1894 

585,190 

401 

68.5 

1895 

597,527 

471 

78.8 

1861-1864 

1,242,234 

516 

41.5 

1891-1895 

2,864,265 

2,077 

72.5 

1866 

330,664 

148 

44.8 

1867 

336,408 

150 

44.6 

1896 

609,864 

434 

71.2 

1868 

342,153 

161 

47.1 

1897 

622,201 

454 

73.0 

1869 

347,898 

167 

48.0 

1898 

634,538 

466 

73.4 

1870 

353,643 

184 

52.0 

1899 

646,875 

525 

81.2 

1900 

659,212 

512 

77.7 

1866-1870 

1,710,766 

810 

47.3 

1896-1900 

3,172,690 

2,391 

75.4 

1871 

362,398 

196 

54.1 

1872 

371,153 

208 

56.0 

1901 

672,145 

487 

72.5 

1873 

379,908 

191 

50.3 

1902 

685,078 

565 

82.5 

1874 

388,663 

215 

55.3 

1903 

698,011 

624 

89.4 

1875 

397,418 

218 

54.9 

1904 

710,944 

673 

94.7 

1905 

723,877 

668 

92.3 

1871-1875 

1,899,540 

1,028 

54.1 

1901-1905 

3,490,055 

3,017 

86.4 

1876 

406,173 

203 

50.0 

1877 

414,928 

219 

52.8 

1906 

736,810 

733 

99.5 

1878 

423,683 

260 

61.4 

1907 

749,743 

732 

97.6 

1879 

432,439 

257 

59.4 

1908 

762,677 

765 

100.3 

1880 

441,195 

268 

60.7 

1909 

775,611 

787 

101.5 

1910 

788,545 

817 

103.6 

1876-1880 

2,118,418 

1,207 

57.0 

1906-1910 

3,813,386 

3,834 

100.5 

1881 

450,659 

290 

64.4 

1882 

460,123 

284 

61.7 

1911 

801,479 

834 

104.1 

1883 

469,587 

273 

58.1 

1912 

814,413 

867 

106.5 

1884 

479,052 

342 

71.4 

1913 

827,347 

939 

113.5 

1885 

488,517 

344 

70.4 
65.3 

1914 
Source: 

840,281           846 
Annual  Reports  of  the 

112.6 

1881-1885 

2,347,938 

1,533 

Bureau  of 

Health  of  the  City  of  Philadelph 

ia.  Pa. 

1886 

497,982 

339 

68.1 

1887 

507,447 

360 

70.9 

1888 

516,912 

322 

62.3 

1889 

526,377 

357 

67.8 

1890 

535,842 

367 

68.5 
67.5 

1886-1890 

2,584,560 

1,745 

545 


APPENDIX  F  {PART  II) 

Table  129 

Mortality  from  Cancer  in  Philadelphia,  Pa.,  by  Organs  and  Parts 

according  to  Sex,  1878-1903  (Excluding  1897-1898) 


Organ  or  Part 


TOTAL 
Deaths         Rate  per 


from 
Cancer 


Buccal  cavity 398 

(Esophagus 87 

Stomach 3,901 

Liver 1,535 

Rectum 438 

Other  intestines 408 

Pancreas 137 

Urinary  organs 231 

Female  generative  organs 3,070 

Breast 1,719 

Skin 441 

Other  or  not  specified  organs  . .  1,325 


All  organs 13,690 


100,000 
Population 

1.6 

0.3 
15.3 

6.0 

1.7 

1.6 

0.5 

0.9 
12.1 

6.8 

1.7 

5.3 

53.8 


MALES 
Deaths        Rate  per 


from 
Cancer 

317 

67 

1,875 

605 

196 

154 

71 

138 

35 
256 


4,403 


100,000 
Population 

2.6 
0.5 
15.1 
4.9 
1.6 
1.2 
0.6 
1.1 

0.3 
2.1 
5.5 

35.5 


FEMALES 
Deaths     Rate  per 
from         100,000 
Cancer   Population 


81 

20 

2,026 

930 

242 

254 

66 

93 

3,070 

1,684 

185 

636 

9,287 


0.6 

0.2 

15.5 

7.1 

1.9 

1.9 

0.5 

0.7 

23.5 

12.9 

1.4 

4.9 

71.1 


Source:     Annual  Reports  of  the  Bureau  of  Health  of  the  City  of  Philadelphia,  Pa. 


Table  130 

Increase  in  the  Mortality  from  Cancer  in  Philadelphia,  Pa.,  by  Organs  and 

Parts,  1891-1902  Compared  with  1903-1912 

Rate  per  100,000  Population  Percentage 

Organ  or  Part                                                                  1891-1902*               1903-1912  of  Increase 

Buccal  cavity 1.6                       3.1  93.8 

Stomach  and  liver 24.7                     29.4  19.0 

Peritoneum  Intestines  and  rectum 3.5                       8.6  145.7 

Female  generative  organs 12.1                     13.9  14.9 

Breast 7.0                       8.7  24.3 

Skin 1.9                      3.5  84.2 

Other  or  not  specified  organs 6.9                     13.3  92.8 

All  organs 57.7                    80.5  39.5 

Source :     Annual  Reports  of  the  Bureau  of  Health  of  the  City  of  Philadelphia,  Pa. 
*1897  and  1898  not  available. 


546 


APPENDIX  F  {PART  II) 

Table  131 

Mortality  from  Cancer  of  the  Buccal  Cavity  in  Philadelphia,  Pa. 

according  to  Age,  1881-1912 


Years 

Deaths 
Population            from 
Cancer 

Rate  per 

100,000 

Population 

Year.^ 

Deaths 
Population             from 

Cancer 

Rate  per 

1 00,000 

Population 

Ages  Undeu  20 

Ages  40-49 

1881-1890 

3,929,590 

3 

0.1 

1881-1890 

1,008,630              19 

1.9 

1891-1902* 

4,450,560 

1 

0.0 

1891-1902 

1,412,790              32 

2.3 

1903-1912 

5,394,240 

Ages  20-29 

9 

0.2 

1903-1912 

1,844,770              66 
Ages  50-59 

3.6 

1881-1890 

1,929,053 

1 

0.1 

1881-1890 

672,701               27 

4.0 

1891-1902 

2,508,823 

1 

0.0 

1891-1902 

888,693              51 

5.7 

1903-1912 

2,976,065 

Ages  30-39 

5 

0.2 

1903-1912 

1,150,485             145 

Ages  60  and  Over 

12.6 

1881-1890 

1,394,740 

5 

0.4 

1881-1890 

624,080              86 

13.8 

1891-1902 

1,939,360 

10 

0.5 

1891-1902 

796,733              97 

12.2 

1903-1912 

2,481,095 

16 

0.6 

1903-1912 

977,620            226 

23.1 

Source:     Annual  Reports  of  the  Bureau 
of  Health  of  the  City  of  Philadelphia,  Pa. 

*1897  and  1898  not  available. 

Table  132 

Mortality  from  Cancer  of  Stomach  and  Liver  in  Philadelphia,  Pa. 

according  to  Age,  1881-1912 


Years 

Deaths 
Population            from 
Cancer 

Ages  Under  20 

Rate  xjer 

100,000 

Population 

Years 

Deaths 
Population            from 
Cancer 

Ages  40-49 

Rate  per 

100,000 

Population 

1881-1890 

3,929,590              13 

0.3 

1881-1890 

1,008,630            321 

31.8 

1891-1902* 

4,450,560              15 

0.3 

1891-1902 

1,412,790            515 

36.5 

1903-1912 

5,394,240              13 
Ages  20-29 

0.2 

1903-1912 

1,844,770            739 
Ages  50-59 

40.1 

1881-1890 

1,929,053              27 

1.4 

1881-1890 

672,701            492 

73.1 

1891-1902 

2,508,823              49 

2.0 

1891-1902 

888,693            794 

89.3 

1903-1912 

2,976,065              42 
Ages  30-39 

1.4 

1903-1912 

1,150,485         1,227 
Ages  60  and  Over 

106.7 

1881-1890 

1,394,740            134 

9.6 

1881-1890 

624,080            854 

136.8 

1891-1902 

1,939,360            225 

11.6 

1891-1902 

796,733         1,362 

170.9 

1903-1912 

2,481,095            228 

9.2 

1903-1912 

977,620        2,103 

215.1 

Source:     Annual  Reports  of  the  Bureau 
of  Health  of  the  City  of  Philadelphia,  Pa. 

*1897  and  1898  not  available. 

547 


APPENDIX  F  (PART  II) 

Table  133 

Mortality  from  Cancer  of  Peritoneum,  Intestines  and  Rectum  in 

Philadelphia,  Pa.,  according  to  Age,  1881-1912 


Years 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Years 

Deaths 
Population            from 
Cancer 

Rate  per 

100,000 

Population 

Ages  Under  20 

Ages  40-49 

1881-1890 

1891-1902* 

1903-1912 

3,929,59C 
4,450,560 
5,394,240 

2 

4 

22 

0.1 
0.1 
0.4 

1881-1890 
1891-1902 
1903-1912 

1,008,630              50 
1,412,790              77 
1,844,770            213 

5.0 

5.5 

11.5 

Ages  20-29 

Ages  50-59 

1881-1890 
1891-1902 
1903-1912 

1,929,053 
2,508,823 
2,976,065 

9 

8 

39 

0.5 
0.3 
1.3 

1881-1890 
1891-1902 
1903-1912 

672,701              71 

888,693            118 

1,150,485            314 

10.6 
13.3 
27.3 

Ages  30-39 

Ages  60  and  Over 

1881-1890 
1891-1902 
1903-1912 

1,394,740 
1,939,360 
2,481,095 

30 

31 

117 

2.2 
1.6 
4.7 

1881-1890 
1891-1902 
1903-1912 

624,080            117 
796,733            178 
977,620           571 

18.7 
22.3 
58.4 

Source:     Annual  Reports  of  the  Bureau 
of  Health  of  the  City  of  Philadelphia,  Pa. 

*1897  and  1898  not  available. 

Table  134 

Mortality  from  Cancer  of  Generative  Organs  in  Philadelphia,  Pa. 

according  to  Age,  1881-1912 


Years 


Population 


Deaths         Rate  per 
from  100,000 

Cancer       Population 


Ages  Undeb  20 

1881-1890     3,929,590                6  0.2 
1891-1902*  4,450,560 

1903-1912     5,394,240                8  0.2 

Ages  20-29 

1881-1890     1,929,053              33  1.7 

1891-1902     2,508,823              32  1.3 

1903-1912     2,976,065              38  1.3 

Ages  30-39 

1881-1890     1,394,740            177  12.7 

1891-1902     1,939,360            193  10.0 

1903-1912     2,481,095            227  9.1 


Years 


1881-1890 
1891-1902 
1903-1912 

1881-1890 
1891-1902 
1903-1912 

1881-1890 
1891-1902 
1903-1912 


Population 


Deaths         Rate  per 
from  100,000 

Cancer       Population 


Ages  40-49 

1,008,630  341  33.8 

1,412,790  395  28.0 

1,844,770  563  30.5 

Ages  50-59 

672,701  327  48.6 

888,693  441  49.6 

1,150,485  617  53.6 
Ages  60  and  Over 

624,080  281  45.0 

796,733  390  48.9 

977,620  602  61.6 


Source:     Annual  Reports  of  the  Bureau 
of  Health  of  the  City  of  Philadelphia,  Pa. 
*1897  and  1898  not  available. 


548 


APPENDIX  F  (PART  II) 

Table  135 

Mortality  from  Cancer  of  the  Breast  in  Philadelphia,  Pa. 

according  to  Age,  1881-1912 


Years 

Deaths 
Population            from 
Cancer 

Ages  Under  20 

Rate  per 

100,000 

Population 

Years 

Deaths 
Population            from 
Cancer 

Ages  40-49 

Rate  per 

100,000 

Population 

1881-1890 

3,929,590                3 

0.1 

1881-1890 

1,008,630            142 

14.1 

1891-1902* 

4,450,560                2 

0.0 

1891-1902 

1,412,790            185 

13.1 

1903-1912 

5,394,240                1 

Ages  20-29 

0.0 

1903-1912 

1,844,770            276 
Ages  50-59 

15.0 

1881-1890 

1,929,053 

0.0 

1881-1890 

672,701             154 

22.9 

1891-1902 

2,508,823               6 

0.2 

1891-1902 

888,693            255 

28.7 

1903-1912 

2,976,065               9 

Ages  30-39 

0.3 

1903-1912 

1,150,485            335 

Ages  60  and  Over 

29.1 

1881-1890 

1,394,740              57 

4.1 

1881-1890 

624,080            262 

42.0 

1891-1902 

1,939,360              78 

4.0 

1891-1902 

796,733            313 

39.3 

1903-1912 

2,481.095            108 

4.4 

1903-1912 

977,620           563 

67.6 

Source:    Annual  Reports  of  the  Bureau 
of  Health  of  the  City  of  Philadelphia,  Pa. 

*1897  and  1898  not  available. 

Table  136 

Mortality  from  Cancer  of  the  Skin  in  Philadelphia,  Pa. 

according  to  Age,  1881-1912 


Years 

Deaths 
Population            from 
Cancer 

Ages  Under  20 

Rate  per 

100,000 

Population 

Years 

Deaths 
Population             from 
Cancer 

Ages  40-49 

Rate  per 

100,000 

Population 

1881-1890 

1891-1902* 

1903-1912 

3,929,590                4 
4,450,560                4 
5,394,240                8 

Ages  20-29 

0.1 
0.1 
0.1 

1881-1890 
1891-1902 
1903-1912 

1,008,630              10 

1,412,790              27 

1,844,770             61 

Ages  50-59 

1.0 
1.9 
3.3 

1881-1890 
1891-1902 
1903-1912 

1,929,053                2 
2,508,823 
2,976,065               7 

Ages  30-39 

0.1 
0.2 

1881-1890 
1891-1902 
1903-1912 

672,701               19 

888,693              48 
1,150,485            105 

Ages  60  and  Over 

2.8 
5.5 
9.1 

1881-1890 
1891-1902 
1903-1912 

1,394,740                 4 
1,939,360              10 
2,481,095              18 

0.3 
0.5 

0.7 

1881-1890 
1891-1902 
1903-1912 

624,080              88 
796,733            144 
977,620            320 

14.1 

18.1 
32.7 

Source:     Annual  Reports  of  the  Bureau 
of  Health  of  the  City  of  Philadelphia,  Pa. 

*1897  and  1898  not  available. 

549 


APPENDIX  F  {PART  II) 

Table  137 

Mortality  from  Cancer  of  Other  or  Not  Specified  Organs  in  Philadelphia,  Pa. 

according  to  Age,  1881-1912 


Years 

D 

Population            f 
C 

=aths 

rom 

ancer 

Rate  per 
100,000 
Population    * 

Years 

Deaths 
Population            from 
Cancer 

Rate  per 

100,000 

Population 

Ages  Undeb  20 

Ages  40-49 

1881-1890 

3.929.590 

20 

0.5 

1881-1890 

1,008,630              83 

8.3 

1891-1902*  4.450,560 

32 

0.7 

1891-1902 

1,412,790            157 

11.1 

1903-1912 

5,394,240 

Ages  20-29 

104 

1.9 

1903-1912 

1,344,770            348 
Ages  50-59 

18.9 

1881-1890 

1,929,053 

17 

0.9 

1881-1890 

672,701            120 

17.8 

1891-1902 

2,508,823 

13 

0.5 

1891-1902 

888,693            194 

21.8 

1903-1912 

2,976,065 

Ages  30-39 

71 

2.4 

1903-1912 

1,150,485            446 

Ages  60  and  Over 

38.8 

1881-1890 

1,394,740 

47 

3.4 

1881-1890 

624,080           231 

37.0 

1891-1902 

1,939,360 

91 

4.7 

1891-1902 

796,733            348 

43.7 

1903-1912 

2,481,095 

154 

6.2 

1903-1912 
Source: 

977,620            854 
Annual  Reports  of  tt 

87.4 
le  Bureau 

of  Health  of  the  City  of  Philadelphia,  Pa. 

*1897  and  1898  not  available. 

Table  138 

Mortality  from  Cancer  in  Philadelphia,  Pa. 

according  to  Age,  1881-1912 


Years 

Deaths 
Population            from 
Cancer 

Ages  Undek  20 

Rate  per 

100,000 

Population 

Years 

Deaths 
Population            from 
Cancer 

Ages  40-49 

Rate  per 

100,000 

Population 

1881-1890 

1891-1902* 

1903-1912 

3,929,590              51 
4,450,560              58 
5,394,240            165 

Ages  20-29 

1.3 
1.3 
3.1 

1881-1890 
1891-1902 
1903-1912 

1,008,630            966 
1,412,790         1,388 
1,844,770         2,266 

Ages  50-59 

95.8 

98.2 

122.8 

1881-1890 
1891-1902 
1903-1912 

1,929,053              89 

2,508,823            109 

2,976,065            211 

Ages  30-39 

4.6 
4.3 
7.1 

1881-1890 
1891-1902 
1903-1912 

672,701         1,210 

888,693         1,901 

1,150,485         3,189 

Ages  60  and  Over 

179.9 
213.9 

277.2 

1881-1890 
1891-1902 
1903-1912 

1,394,740            454 
1,939,360            638 
2,481,095            868 

32.6 
32.9 
35.0 

1881-1890 
1891-1902 
1903-1912 

624,080         1,919 
796,733         2,832 
977,620        5,239 

307.5 
355.5 
535.9 

Source:     Annual  Reports  of  the  Bureau 
of  Health  of  the  City  of  Philadelphia,  Pa. 
*1897  and  1898  not  available. 

550 


APPENDIX  F  {PART  II) 

Table  139 
Mortality  from  Cancer  in  Pittsburgh,  Pa. 

1888-1913 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1888 

222,019 

79 

35.6 

1901 

327,468 

147 

44.9 

1889 

230,318 

79 

34.3 

1902 

333,320 

185 

55.5 

1890 

238,617 

93 

39.0 

1903 

339,172 

197 

58.1 

1904 

345,024 

179 

51.9 

1891 

246,916 

82 

33.2 

1905 

350,876 

200 

57.0 

1892 

255,216 

87 

34.1 

1893 

263,516 

116 

44.0 

1901-1905 

1,695,860 

908 

53.5 

1894 

271,816 

137 

50.4 

1895 

280,116 

112 

40.0 

1906 

356,728 

244 

68.4 

1907 

362,581 

239 

65.9 

1891-1895 

1,317,580 

534 

40.5 

1908 

517,425 

323 

62.4 

1909 

525.665 

367 

69.8 

1896 

288,416 

129 

44.7 

1910 

533,905 

351 

65.7 

1897 

296,716 

138 

46.5 

1898 

305,016 

113 

37.0 

1906-1910 

2,296,304 

1,524 

66.4 

1899 

313.316 

132 

42.1 

1900 

321,616 

167 

51.9 

1911 

542,145 

371 

68.4 

1912 

550,385 

368 

66.9 

1896-1900 

1,525,080 

679 

44.5 

1913 

558,625 

348 

62.3 

Source : 

1888-1899 

and  1910-1913,  An- 

nual  Reports  of  the  Department  of  Public 
Health  of  the  City  of  Pittsburgh,  Pa.,  1900- 
1909,  United  States  Mortality  Statistics. 

Table  140 
Mortality  from  Cancer  in  Pittsburgh,  Pa. 
1888-1899  and  1910-1913 


Males 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1888 

116,187 

26 

22.4 

1896 

149,158 

40 

26.8 

1889 

120,308 

23 

19.1 

1897 

153,280 

56 

36.5 

1890 

124,429 

28 

22.5 

1898 

157,402 

42 

26.7 

1899 

161,524 

45 

27.9 

1891 

128,550 

33 

25.7 

1892 

132,671 

39 

29.4 

1896-1899 

621,364 

183 

29.5 

1893 

136,792 

47 

34.4 

1894 

140,914 

53 

37.6 

1910 

273,589 

140 

51.2 

1895 

145,036 

39 

26.9 

1911 

277,717 

143 

51.5 

1912 

281,845 

161 

57.1 

1891-1895 

683,963 

211 

30.8 

1913 
1910-1913 

285,973 

143 

50.0 

1,119,124 

587 

52.5 

Source: 

Annual  Reports  of  the  Depart- 

ment   of   PubHc    Health 

of    the 

City  of 

Pittsburgh, 

Pa. 

551 


APPENDIX  F  {PART  II) 

Table  141 
Mortality  from  Cancer  in  Pittsburgh,  Pa. 
1888-1899  and  1910-1913 


Females 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1888 

105,832 

53 

50.1 

1896 

139,258 

89 

63.9 

1889 

110,010 

56 

50.9 

1897 

143,436 

82 

57.2 

1890 

114,188 

65 

56.9 

1898 

147,614 

71 

48.1 

1899 

151,792 

87 

57.3 

1891 

118,366 

49 

41.4 

1892 

122,545 

48 

39.2 

1896-1899 

582,100 

329 

66.5 

1893 

126,724 

69 

54.4 

1894 

130,902 

84 

64.2 

1910 

260,316 

211 

81.1 

1895 

135,080 

73 

54.0 

1911 

264,428 

228 

86.2 

1912 

268,540 

207 

77.1 

1891-1895 

633,617 

323 

51.0 

1913 
1910-1913 

272,652 

205 

75.2 

1,065,936 

851 

79.8 

Source: 

Annual  Reports  of  the  Depart- 

ment  of   Public   Health 

of    the 

City  of 

Pittsburgh 

Pa. 

Table  142 

Mortality  from  Cancer  in  Pittsburgh,  Pa.,  according  to  Age 

1893-1902  Compared  with  1903-1912 


1893-1902 

1903-1912 

Deaths 

Rate  per 

Deaths 

Rate  per 

Percent- 

Ages 

Population 

from 

100,000 

Population 

from 

100,000 

age  of 

Cancer 

Population 

Cancer 

Population 

Increase 

Under  20.... 

.   1,241,832 

21 

1.7 

1,715,100 

38 

2.2 

29.4 

20-29 

.      653,622 

56 

8.6 

922,635 

76 

8.2 

-4.7 

30-39 

.      470,309 

153 

32.5 

748,980 

260 

34.7 

6.8 

40-49 

.      319,236 

313 

98.0 

511,565 

673 

112.0 

14.3 

50-59 

.      179,958 

371 

206.2 

295,010 

756 

256.3 

24.3 

60  and  over.. 

.      132.615 

462 

348.4 
45.9 

221,383 

1,136 

613.1 
64.3 

47.3 

All  Ages 

.   2,997,572 

1,376 

4,414,673 

2,839 

40.1 

Source:     Annual  Reports   of   the    Department  of    Public    Health    of    the    City    of 
Pittsburgh,  Pa. 


552 


APPENDIX  F  {PART  II) 

Table  143 

Mortality  from  Cancer  in  Pittsburgh,  Pa.,  by  Organs  and  Parts 

according  to  Age,  1888-1899 

Deaths  from  Canceb 

(Esophagus  _  Female  All 

Stomach        Intestines       Generative  Other 

Ages  All  Organs  Liver  Rectum  Organs  Breast  Organs 

Under  30 79  15  10  8  4  42 

30-39 152  46  17  43  11  35 

40-49 300  102  24  89  25  60 

60-59 320  138  28  55  29  70 

60  and  over 446  219  31  65  27  104 

Allages 1,297  520  110  260  96  311 

Rate  per  100,000  Population 

Under  30 3.8  0.7  0.5  0.4  0.2  2.0 

30-39 31.2  9.4  3.5  8.8  2.3  7.2 

40-49 91.0  30.9  7.3  27.0  7.6  18.2 

50-59 170.6  73.5  14.9  29.3  15.5  37.3 

60  and  over 320.5  157.4  22.2  46.7  19.4  74.7 

Allages 40.4  16.2  3.5  8.1  3.0  9.6 

Source:     Annual  Reports  of  the    Department    of    Public   Health  of  the   City  of 
Pittsburgh,  Pa. 

Table  144 

Mortality  from  Cancer  in  Pittsburgh,  Pa.,  by  Organs  and  Parts 

according  to  Sex,  1888-1899 


TOTAL 

MALES 

FEMALES 

Deaths 

Rate  per 

Deaths 

Rate  per 

Deaths 

Rate  per 

Organ  or  Part 

from 

100,000 

from 

100,000 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

Cancer 

Population 

Buccal  cavity 

27 

0.8 

22 

1.3 

5 

0.3 

(Esophagus 

18 

0.6 

12 

0.7 

6 

0.4 

Stomach 

354 

11.0 

178 

10.7 

176 

11.4 

Liver 

148 

4.6 

66 

4.0 

82 

5.3 

Rectum 

50 

1.6 

18 

1.1 

32 

2.1 

Other  intestines 

60 
30 

1.9 
0.9 

18 
17 

1.1 
1.0 

42 
13 

2.7 

Urinary  organs 

0.8 

Female  generative  organs . . . 

260 

8.1 

260 

16.8 

Breast 

96 

3.0 

96 

6.2 

Skin 

33 
17 

1.0 
0.5 

20 

8 

1.2 
0.5 

13 
9 

0.8 

Bones 

0.6 

Other'organs 

74 

2.3 

52 

3.1 

22 

1.4 

Not  specified 

130 

4.1 
40.4 

60 

3.6 
28.3 

70 

4.6 

All  organs 

. .      1,297 

471 

826 

53.4 

Source:     Annual    Reports  of   the    Department   of   Public    Health  of  the    City  of 
Pittsburgh,  Pa. 


553 


APPENDIX  F  {PART  II) 

Table  145 

Mortality  from  Cancer  in  Pittsburgh,  Pa.,  by  Organs  and  Parts 

according  to  Sex,  1910-1913 


TOTAL 

MALES 

FEMALES 

Organ  or  Part 

Deaths 

from 

Cancer 

Rate  per 

100,000 

Population 

Deaths 

from 
Cancer 

Rate  per 

100,000 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Buccal  cavity 

35 

1.6 

32 

2.9 

3 

0.3 

Stomach  and  liver 

541 

24.8 

258 

23.1 

283 

26.5 

Peritoneum,  intestines,  rectum 

151 

6.9 

64 

5.7 

87 

8.2 

Female  generative  organs 

Breast 

244 
86 

11.2 
3.9 

244 
86 

22.9 
8.1 

Skin 

35 

1.6 

17 

1.4 

18 

1.7 

Other  or  not  specified  organs  . . 

201 

9.2 

59.2 

140 

12.6 

45.7 

61 

5.7 

All  organs 

1,293 

511 

782 

73.4 

Source:  Annual  Reports  of  the  Department  of  Public  Health,  City  of  Pittsburgh, 
Pa.,  1910,  1911;  Annual  Reports,  Bureau  of  Infectious  Diseases,  City  of  Pittsburgh,  Pa., 
1912, 1913.     Deaths  of  non-residents  are  excluded. 

Table  146 

Increase  in  the  Mortality  from  Cancer  in  Pittsburgh,  Pa.,  by  Organs  and 

Parts,  according  to  Sex,  1888-1899  Compared  with  1910-1913 

TOTAL 

Rate  per  100,000  Population  Percentage 

Organ  or  Part                                                          1888-1899  1910-1913  of  Increase 

Buccal  cavity 0.8  1.6  100.0 

Stomach  and  liver 16.2  24.8  53.1 

Peritoneum,  intestines  and  rectum 3.5  6.9  97.1 

Generative  organs 8.1  11.2  38.3 

Breast 3.0  3.9  30.0 

Skin 1.0  1.6  60.0 

Other  ornot  specified  organs 7.8  9.2  17.9 

All  organs 40.4  59.2  46.5 

MALES 

Buccal  cavity 1.3  2.9  123.1 

Stomach  and  liver 15.4  23.1  50.0 

Peritoneum,  intestines  and  rectum 2.2  5.7  159.1 

Skin 1.2  1.4  16.7 

Other  or  not  specified  organs 8.2  12.6  53.7 

All  organs 28.3  45.7  '  61.6 

FEMALES 

Buccal  cavity 0.3  0.3  0.0 

Stomach  and  liver 17.1  26.5  65.0 

Peritoneum,  intestines  and  rectum 4.8  8.2  70.8 

Generative  organs 16.8  22.9  36;3 

Breast 6.2  8.1  30.6 

Skin 0.8  1.7  112.5 

Other  or  not  specified  organs 7.4  5.7  — 23.0 

All  organs 53.4  73.4  37.5 

Source:  Annual  Reports  of  the  Department  of  Public  Health  of  the  City  of 
Pittsburgh,  Pa. 


554 


APPENDIX  F  {PART  II) 

Table  147 

Mortality  from  Cancer  in  Providence,  R.  I. 

1881-1914 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1881 

107,499 

65 

60.5 

1901 

180,204 

143 

79.4 

.      1882 

110,141 

52 

47.2 

1902 

184,811 

156 

84.4 

1883 

112,784 

84 

74.5 

1903 

189,419 

151 

79.7 

1884 

115,427 

70 

60.6 

1904 

194,027 

185 

95.3 

1885 

118,070 

88 

74.5 
63.7 

1905 
1901-1905 

198,635 

189 

95.1 

1881-1885 

563,921 

359 

947,096 

824 

87.0 

1886 

120,885 

87 

72.0 

1906 

203,773 

186 

91.3 

1887 

123,700 

76 

61.4 

1907 

208,911 

222 

106.3 

1888 

126,515 

87 

68.8 

1908 

214,049 

187 

87.4 

1889 

129,330 

77 

59.5 

1909 

219,187 

217 

99.0 

1890 

132,146 

72 

54.5 
63.1 

1910 
1906-1910 

224,326 

225 
1,037 

100.3 

1886-1890 

632,576 

399 

1,070,246 

96.9 

1891 

134,811 

81 

60.1 

1911 

229,464 

221 

96.3 

1892 

137,476 

77 

56.0 

1912 

234,602 

248 

105.7 

1893 

140,141 

95 

67.8 

1913 

239,740 

253 

105.5 

1894 

142,806 

78 

54.6 

1914 

244,878 

225 

91.9 

1895 

145,472 

96 

66.0 
60.9 

Source: 
riages  and 
dence,  R.  '. 

Annual  Reports  on  Births,  Mar- 
Deaths  of  the  City  of  Provi- 

1891-1895 

700,706 

427 

1896 

151,497 

89 

58.7 

1897 

157,522 

101 

64.1 

1898 

163,547 

120 

73.4 

1899 

169,572 

132 

77.8 

1900 

175,597 

133 

75.7 
70.3 

1896-1900 

817,735 

575 

555 


APPEXDIX  F  (PART  II) 

Table  148 

Mortality  from  Cancer  in  Providence,  R.  I.,  Males 

1881-1914 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

51,116 

18 

35.2 

1901 

87,435 

42 

48.0 

1882 

52,449 

14 

26.7 

1902 

89,800 

51 

56.8. 

1883 

53,787 

26 

48.3 

1903 

92,171 

46 

49.9 

1884 

55,116 

19 

34.5 

1904 

94,549 

56 

59.2 

1885 

56,449 

15 

26.6 
34.2 

1905 

1901-1905 

96,934 

68 

70.2 

1881-1885 

268,917 

92 

460,889 

263 

57.1 

1886 

57,868 

28 

48.4 

1906 

99,584 

52 

52.2 

1887 

59,289 

19 

32.0 

1907 

102,241 

67 

65.5 

1888 

60,715 

28 

46.1 

1908 

104,905 

67 

63.9 

1889 

62,143 

20 

32.2 

1909 

107,577 

75 

69.7 

1890 

63,575 

15 

23.6 
36.2 

1910 
1906-1910 

110,279 

73 

66.2 

1886-1890 

303,590 

110 

524,586 

334 

63.7 

1891 

64,898 

.     21 

32.4 

1911 

112,988 

78 

69.0 

1892 

66,222 

21 

31.7 

1912 

115,706 

89 

76.9 

1893 

67,548 

16 

23.7 

1913 

118,426 

83 

70.1 

1894 

68,875 

31 

45.0 

1914 

121,156 

82 

67.7 

1895 

70,205 

28 

39.9 

Source: 

Annual  Reports  on  Births,  Mar- 

1891-1895 

337,748 

117 

34.6 

riages  and 
dence,  R.  ] 

Deaths  of 

the  City 

of  Provi- 

1896 

73,158 

25 

34.2 

1897 

76,130 

31 

40.7 

1898 

79,108 

31 

39.2 

1899 

82,090 

43 

52.4 

' 

1900 

85,077 

46 

54.1 

44.5 

1896-1900 

395,563 

176 

556 


APPENDIX  F  {PART  II) 

Table  149 

Mortality  from  Cancer  in  Providence,  R.  I.,  Females 

1881-1914 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

56,383 

47 

83.4 

1901 

92,769 

101 

108.9 

1882 

57,692 

38 

65.9 

1902 

95,011 

105 

110.5 

1883 

58,997 

58 

98.3 

1903 

97,248 

105 

108.0 

1884 

60,311 

51 

84.6 

1904 

99,478 

129 

129.7 

1885 

61,621 

73 

118.5 
90.5 

1905 
1901-1905 

101,701 

121 

119.0 

1881-1885 

295,004 

267 

486,207 

561 

115.4 

1886 

63,017 

59 

93.6 

1906 

104,189 

134 

128.6 

1887 

64,411 

57 

88.5 

1907 

106,670 

155 

145.3 

1888 

65,800 

59 

89.7 

1908 

109,144 

120 

109.9 

1889 

67,187 

57 

84.8 

1909 

111,610 

142 

127.2 

1890 

68,571 

57 

83.1 

87.8 

1910 
1906-1910 

114,047 

152 

133.3 

1886-1890 

328,986 

289 

545,660 

703 

128.8 

1891 

69,913 

60 

85.8 

1911 

116,476 

143 

122.8 

1892 

71,254 

56 

78.6 

1912 

118,896 

159 

133.7 

1893 

72,593 

79 

108.8 

1913 

121,314 

170 

140.1 

1894 

73,931 

47 

63.6 

1914 

123,722 

143 

115.6 

1895 

75,267 

68 

90.3 

Source: 

Annual  Reports  on  Births,  Mar- 

1891-1895 

362,958 

310 

85.4 

riages  and 

Deaths  of  the  City 

of  Provi- 

dence,  R.  I 

1896 

78,339 

64 

81.7 

1897 

81,392 

70 

86.0 

1898 

84,439 

89 

105.4 

1899 

87,482 

89 

101.7 

1900 

90,520 

87 

96.1 
94.5 

1896-1900 

422,172 

399 

Table  150 

Mortality  from  Cancer  in  Providence,  R.  I.,  by  Organs  and  Parts 

according  to  Sex,  1903-1912 


Organ  or  Part 

Buccal  cavity 

Stomach  and  liver 

Peritoneum,  intestines,  rectum 

Female  generative  organs 

Breast 

Skin 

Other  or  not  specified  organs  .  . 


TOTAL 

Deaths       Rate  per 
100,000 
Population 

3.3 


from 
Cancer 


70 
640 
328 
393 
257 

54 
289 


All  organs 2,031 


30.2 
15.5 
18.5 
12.1 
2.5 
13.6 

95.7 


MALES 

Deaths  Rate  per 

from  100,000 

Cancer  Population 

57  5.5 

297  28.6 

131  12.6 


5 

30 
151 


671 


0.5 

2.9 

14.4 

64.5 


FEMALES 
Deaths      Rate  per 
100,000 
Population 

1.2 


from 
Cancer 


13 
343 
197 
393 

252 

24 

138 


31.7 
18.2 
36.3 
23.3 
2.2 
12.8 


1,360         125.7 


Source:     Annual  Reports  on  Births,  Marriages  and  Deaths  of  the  City  of  Providence, 
R.  I. 


557 


APPENDIX  F  (PART  II) 

Table  151 

Mortality  from  Cancer  in  Richmond,  Va. 

1879-1914 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1879 

62,343 

19 

30.5 

1901 

89,307 

47 

52.6 

1880 

63,600 

19 

29.9 

1902 

93,564 

26 

27.8 

1903 

97,822 

50 

51.1 

1882 

67,156 

21 

31.3 

1904 

102,080 

52 

50.9 

1883 

68,935 

29 

42.1 

1905 

106,338 

45 

42.3 

1884 

70,714 

22 

31.1 

1901-1905 

489,111 

220 

45.0 

1882-1884 

206,805 

72 

34.8 

1906 

110,596 

75 

67.8 

1886 

74,272 

26 

35.0 

1907 

114,854 

80 

69.7 

1887 

76,051 

21 

27.6 

1908 

119,112 

84 

70.5 

1888 

,   , 

1909 

123,370 

92 

74.6 

1889 

79,609 

37 

46.5 

1910 

127,628 

109 

85.4 

1890 

81,388 

36 

44.2 

1906-1910 

595,560 

440 

73.9 

1886-1890 

311,320 

120 

38.5 

1911 

131,886 

113 

85.7 

1891 

81,754 

26 

31.8 

1912 

136,144 

120 

88.1 

1892 

82,120 

23 

28.0 

1913 

140,402 

115 

81.9 

1893 

82,486 

32 

38.8 

1914 

144,658 

125 

86.4 

1894 

82,852 

29 

35.0 

1895 

83,218 

24 

28.8 

Source: 

Annual  Reports  of  the  Health 

Department  of  the  City 

of  Richmond,  Va. 

1891-1895 

412,430 

134 

32.5 

1896 

83,584 

35 

41.9 

•■ 

1897 

83,950 

36 

42.9 

1898 

84,316 

21 

24.9 

1899 

84,683 

30 

35.4 

1900 

85,050 

39 

45.9 

38.2 

1896-1900 

421,583 

161 

558 


APPENDIX  F  {PART  II) 


Table  152 

Table  153 

Mortality  from  Cancer  in  Richmond,   | 

Mortality  from  Cancer  in  Richmond, 

Va 

.,  Males, 

1882 

-1913 

aths 

Rate  per 

Va. 

,  Females, 

1882-1913 

De 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1882 

31,598 

4 

12.7 

1882 

35,558 

17 

47.8 

1883 

32,431 

6 

18.5 

1883 

36,504 

23 

63.0 

1884 

33,265 

6 
16 

18.0 
16.4 

1884 
1882-1884 

37,449 

16 

42.7 

1882-1884 

97,294 

109,511 

56 

51.1 

1886 

34,931 

5 

14.3 

1886 

39,341 

21 

53.4 

1887 

35,764 

8 

22.4 

1887 

40,287 

13 

32.3 

1888 

1888 

1889 

37,429 

9 

24.0 

1889 

42,180 

28 

66.4 

1890 

38,261 

14 

36 

36.6 
24.6 

1890 
1886-1890 

43,127 

22 

51.0 

1886-1890 

146,385 

164,935 

84 

50.9 

1891 

38,428 

12 

31.2 

1891 

43,326 

14 

32.3 

1892 

38,595 

9 

23.3 

1892 

43,525 

14 

32.2 

1893 

38,762 

6 

15.5 

1893 

43,724 

26 

59.5 

1894 

38,929 

5 

12.8 

1894 

43,923 

24 

54.6 

1895 

39,096 

5 

37 

12.8 
19.1 

1895 
1891-1895 

44,122 

19 

43.1 

1891-1895 

193,810 

218,620 

97 

44.4 

1896 

39,264 

14 

35.7 

1896 

44,320 

21 

47.4 

1897 

39,432 

16 

40.6 

1897 

44,518 

20 

44.9 

1898 

39,600 

8 

20.2 

1898 

44,716 

13 

29.1 

1899 

39,768 

9 

22.6 

1899 

44,915 

21 

46.8 

1900 

39,936 

15 

62 

37.6 
31.3 

1900 
1896-1900 

45,114 

24 

53.2 

1896-1900 

198,000 

223,583 

99 

44.3 

1901 

42,032 

13 

30.9 

1901 

47,275 

34 

71.9 

1902 

44,129 

4 

9.1 

1902 

49,435 

22 

44.5 

1903 

46,226 

8 

17.3 

1903 

51,596 

42 

81.4 

1904 

48,323 

13 

26.9 

1904 

53,757 

39 

72.5 

1905 

50,420 

18 

35.7 

1905 

55,918 

27 

48.3 

1901-1905 

231,130 

56 

24.2 

1901-1905 

257,981 

164 

63.6 

1906 
1907 
1908 
1909 
1910 

52,517 
54,614 
56,711 
58,808 
60,905 

24 
30 
28 
31 
39 

45.7 
54.9 
49.4 
52.7 
64.0 

53.6 

1906 
1907 
1908 
1909 
1910 

1906-1910 

58,079 
60,240 
62,401 
64,562 
66,723 

51 
50 
56 
61 
70 

87.8 
83.0 
89.7 
94.5 
104.9 

1906-1910 

283,555 

152 

312,005 

288 

92.3 

1911 
1912 
1913 

63,002 
65,099 
67,196 

32 

42 
42 

50.8 
64.5 
62.5 

1911 
1912 
1913 

68,884 
71,045 
73,206 

81 
78 
73 

117.6 

109.8 

99.7 

Source:    Annual  Reports  of  the  Health 
Department  of  the  City  of  Richmond,  Va. 

Source:    Annual  Reports  of  the  Health 
Department  of  the  City  of  Richmond,  Va. 

559 


37 


APPENDIX  F  {PART  II) 


Table  154 

Table  155 

Mortality  from  Cancer  in  Richmond, 

Mortality  from  Cancer  in  Richmond, 

Va.,  White, 

1879-1914 

Rate  per 

Va 

.,  Colored, 

1879-1914 

Deaths 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1879 

34,981 

12 

34.3 

1879 

27,362 

7 

25.6 

1880 

35,765 

14 

39.1 

1880 

27,835 

5 

18.0 

1882 

38,418 

13 

33.8 

1882 

28,738 

8 

27.8 

1883 

39,745 

16 

40.3 

1883 

29,190 

13 

44.5 

1884 

41,072 

13 

31.7 
35.2 

1884 
1882-1884 

29,642 

9 

30 

30.4 

1882-1884 

119,235 

42 

87,570 

34.3 

1886 

43,726 

16 

36.6 

1886 

30,546 

10 

32.7 

1887 

45,053 

18 

40.0 

1887 

30,998 

3 

9.7 

1888 

,    , 

1888 

1889 

47,707 

23 

48.2 

1889 

31,902 

14 

43.9 

1890 

49,034 

23 

46.9 
43.1 

1890 
1886-1890 

32,354 

13 
40 

40.2 

1886-1890 

185,520 

80 

125,800 

31.8 

1891 

49,410 

19 

38.5 

1891 

32,344 

7 

21.6 

1892 

49,786 

15 

30.1 

1892 

32,334 

8 

24.7 

1893 

50,162 

26 

51.8 

1893 

32,324 

6 

18.6 

1894 

50,538 

18 

35.6 

1894 

32,314 

11 

34.0 

1895 

50,914 

19 

37.3 
38.7 

1895 
1891-1895 

32,304 

5 
37 

15.5 

1891-1895 

250,810 

97 

161,620 

22.9 

1896 

51,290 

28 

54.6 

1896 

32,294 

7 

21.7 

1897 

51,667 

28 

54.2 

1897 

32,283 

8 

24.8 

1898 

52,044 

10 

19.2 

1898 

32,272 

11 

34.1 

1899 

62,421 

24 

45.8 

1899 

32,262 

6 

18.6 

1900 

52,798 

26 

49.2 
44.6 

1900 
1896-1900 

32,252 

13 
45 

40.3 

1896-1900 

260,220 

116 

161,363 

27.9 

1901 

55,QQQ 

28 

50.4 

1901 

33,701 

19 

56.4 

1902 

58,414 

19 

32.5 

1902 

35,150 

7 

19.9 

1903 

61,222 

32 

52.3 

1903 

36,600 

18 

49.2 

1904 

64,030 

31 

48.4 

1904 

38,050 

21 

55.2 

1905 

66,838 

30 

44.9 
45.7 

1905 
1901-1905 

39,500 

15 
80 

38.0 

1901-1905 

306,110 

140 

183,001 

43.7 

1906 

69,646 

53 

76.1 

1906 

40,950 

22 

53.7 

1907 

72,454 

51 

70.4 

1907 

42,400 

29 

68.4 

1908 

75,262 

62 

82.4 

1908 

43,850 

22 

50.2 

1909 

78,070 

66 

84.5 

1909 

45,300 

26 

57.4 

1910 

80,879 

83 
315 

102.6 
83.7 

1910 
1906-1910 

46,749 

26 

65.6 

1906-1910 

376,311 

219,249 

125 

57.0 

1911 

83,687 

80 

95.6 

1911 

48,199 

33 

68.5 

1912 

86,495 

88 

101,7 

1912 

49,649 

32 

64.5 

1913 

89,306 

81 

90.7 

1913 

51,096 

34 

66.5 

1914 

92,117 

89 

96.6 

1914 

52,541 

36 

68.5 

Source: 

Annual  Reports  of  th 

3  Health 

Source: 

Annual  Reports  of  th 

e  Health 

Department  of  the  City  of  Richmond,  Vn. 

Department  of  the  City  of  Richmond,  Va. 

500 


APPENDIX  F  (PART  II) 

Table  156 

Mortality  from  Cancer  in  Richmond,  Va.,  by  Organs  and  Parts 

according  to  Sex,  1903-1912 


Organ  or  Part 

Buccal  cavity 

Stomach  and  liver 

Peritoneum,  intestines,  rectum 

Female  generative  organs 

Breast 

Skin 

Other  or  not  specified  organs  . . 


TOTAL 

Deaths        Rate  per 
100,000 
Population 

3.4 


from 
Cancer 


40 
218 

81 
211 

85 

14 
171 


18.6 
6.9 

18.0 
7.3 
1.2 

14.7 


MALES 
Deaths        Rate  per 
100,000 
Population 

5.4 

15.8 

6.1 


from 
Cancer 

30 


34 


11 
102 


2.0 
18.3 


FEMALES 
Deaths       Rate  per 
100,000 
Population 

1.6 


from 
Cancer 


10 
130 

47 
211 

85 
3 

69 


21.2 
7.7 

34.4 

13.9 
0.5 

11.2 


All  organs ; 820  70.1  265  47.6  555  90.5 

Source:    Annual  Reports  of  the  Health  Department  of  the  City  of  Richmond,  Va. 


Table  157 

Mortality  from  Cancer  in  Rochester,  N.  Y. 

1891-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1891 

139,365 

89 

63.9 

1906 

188,962 

170 

90.0 

1892 

144,834 

75 

51.8 

1907 

196,258 

165 

84.1 

1893 

147,055 

77 

52.4 

1908 

203,555 

175 

86.0 

1894 

149,276 

102 

68.3 

1909 

210,852 

179 

84.9 

1895 

151,498 

99 

65.3 
60.4 

1910 
1906-1910 

218,149 

209 

95.8 

1891-1895 

732,028 

442 

1,017,776 

898 

88.2 

1896 

153,720 

103 

67.0 

1911 

225,445 

207 

91.8 

1897 

155,942 

124 

79.5 

1912 

232,741 

226 

97.1 

1898 

158,164 

110 

69.5 

1913 

240,037 

227 

94.6 

1899 

160,386 

115 

71.7 

1900 

162,608 

102 

62.7 

Source: 

1891-1894, 

Monthly 

Reports 

of  the  State  Board  of  H 

ealth  of  N 

ew  York; 

1896-1900 

790,820 

554 

70.1 

1895-1913, 

Annual  Reports  of  the  Health 

Bureau  of  the  City  of  Rochester, 

N.  Y. 

1901 

166,419 

154 

92.5 

1902 

170,280 

157 

92.2 

1903 

174,042 

138 

79.3 

1904 

177,854 

156 

87.7 

1905 

181,666 

164 

90.3 
88.4 

1901-1905 

870,211 

769 

561 


APPENDIX  F  {PART  II) 


Table  158 

Table  159 

Mortality  from-Cancer  in  Rochester, 

Mortality  from  Cancer  in  San 

N. 

Y.,  by  Sex, 

1900-1913 

S 

Fra 

Year 

ncisco,  Cal. 

,  1884-1 

Deaths 

913 

MALE 

Rate  per 

Deaths 

Rate  per 

(Ending 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

June  30) 

Cancer 

Population 

Cancer 

Population 

1884 

259,973 

166 

63.9 

1900 

77,520 

34 

43.9 

1885 

266,477 

136 

51.0 

1901 

79,699 

45 

56.5 

1886 

272,981 

180 

65.9 

1902 

81,878 

56 

68.4 

1887 

279,485 

184 

65.8 

1903 

84,057 

55 

65.4 

1888 

285,989 

190 

66.4 

190<i 

86,237 

61 

70.7 

1889 

292,493 

198 

67.7 

1905 

88,417 

56 

63.3 
65.0 

1890 
1886-1890 

298,997 

216 

72.2 

1901-1905 

420,288 

273 

1,429,945 

968 

67.7 

1906 

92,404 

63 

68.2 

1891 

303,375 

227 

74.8 

1907 

96,391 

56 

58.1 

1892 

307,753 

243 

79.0 

1908 

100,378 

60 

59.8 

1893 

312,131 

210 

67.3 

1909 

104,365 

62 

59.4 

1894 

316,509 

239 

75.5 

1910 

108,352 

91 
332 

84.0 
66.1 

1895 
1891-1895 

320,887 

291 

90.7 

1906-1910 

501,890 

1,560,655 

1,210 

77.5 

1911 

112,339 

75 

66.8 

1896 

325,266 

322 

99.0 

1912 

116,326 

68 

58.5 

1897 

329,645 

344 

104.4 

1913 

120,313 

86 

71.5 

1898 

334,024 

373 

111.7 

1899 

338,403 

353 

104.3 

FEMALES 
85,088              68 

79.9 

1900 
1896-1900 

342,782 

400 

116.7 

1900 

1,670,120 

1,792 

107.3 

1901 

86,720 

109 

125.7 

1901 

350,195 

398 

113.7 

1902 

88,352 

101 

114.3 

1902 

357,608 

387 

108.2 

1903 

89,985 

83 

92.2 

1903 

365,021 

415 

113.7 

1904 

91,617 

95 

103.7 

1904* 

372,434 

484 

130.0 

1905 

93,249 

108 

115.8 
110.2 

1905* 
1901-1905 

379,847 

456 

120.0 

1901-1905 

449,923 

496 

1,825,105 

2,140 

117.3 

1906 

96,558 

107 

110.8 

1906* 

387,260 

367 

94.8 

1907 

99,867 

109 

109.1 

1907 

394,673 

357 

90.5 

1908 

103,177 

115 

111.5 

1908 

402,086 

445 

110.7 

1909 

106,487 

117 

109.9 

1909 

409,499 

418 

102.1 

1910 

109,797 

118 

107.5 
109.7 

1910 
1906-1910 

416,912 

473 

113.5 

1906-1910 

515,886 

566 

2,010,430 

2,060 

102.5 

1911 

113,106 

132 

116.7 

1911 

424,325 

466 

109.8 

1912 

116,415 

158 

135.7 

1912 

431,738 

486 

112.6 

1913 

119,724 

141 

117.8 

1913 

439,151 

555 

126.4 

Source: 

1891-1894, 

Monthly 

Reports 

Source: 

Annual  Reports  of  the  Depart- 

of  the  State  Board  of  Health  of  New  York; 

ment  of  Public  Health  of  the  City  of  San 

1895-1913, 

Annual  Reports  of  th 

e  Health 

Francisco, 

Cal. 

Bureau  of  the  City  of  Rochester, 

N.  Y. 

*Calendar  Years,  Data  from  United  States  Mor- 

tality Statistics. 

562 


APPENDIX  F  (PART  II) 

Table  160 

Mortality  from  Cancer  in  San  Francisco,  Cal.,  Males 

1884-1913 


Year 

Deaths 

Rate  per 

(Ending 

Population 

from 

100,000 

June  30) 

Cancer 

Population 

1884 

148,355 

69 

46.5 

1885 

151,929 

71 

46.7 

1886 

155,503 

79 

50.8 

1887 

159,077 

75 

47.1 

1888 

162,651 

101 

62.1 

1889 

166,225 

89 

53.5 

1890 

169,800 

109 

64.2 

1886-1890 

813,256 

453 

55.7 

1891 

171,306 

93 

54.3 

1892 

172,812 

114 

66.0 

1893 

174,318 

102 

58.5 

1894 

175,824 

117 

66.5 

1895 

177,331 

148 

83.5 

1891-1895 

871,591 

574 

65.9 

1896 

178,838 

170 

95.1 

1897 

180,345 

187 

103.7 

1898 

181,852 

182 

100.1 

1899 

183,359 

186 

101.4 

1900 

184,866 

210 

113.6 

1896-1900 

909,260 

935 

102.8 

1901 

190,069 

192 

101.0 

1902 

195,272 

172 

88.1 

1903 

200,475 

205 

102.3 

1901-1903 

585,816 

569 

97.1 

1907 

221,289 

183 

82.7 

1908 

226,493 

234 

103.3 

1909 

231,697 

212 

91.5 

1910 

236,901 

236 

99.6 

1907-1910 

916,380 

865 

94.4 

1911 

242,105 

247 

102.0 

1912 

247,309 

254 

102.7 

1913 

252,513 

286 

113.3 

Source:     Annual  Reports  of  the  Department  of    Public 
Health  of  the  City  of  San  Francisco,  Cal. 


563 


APPENDIX  F  {PART  II) 


Table  161 
Mortality  from  Cancer  in  San  Francisco,  Cal. 
1884-1913 


Females 


Year 

Deaths 

Rate  per 

Deaths 

Rate  per 

Population 

from 

100,000 

(Ending 

Population 

from 

100,000 

June  aO) 

Cancer 

Population 

June  30) 

Cancer 

Population 

1884 

111,618 

97 

86.9 

19.01 

160,126 

206 

128.6 

1885 

114,548 

65 

56.7 

1902 

162,336 

215 

132.4 

101 

86.0 

1903 

164,546 

210 

127.6 

1886 

117,478 

1887 

120,408 

109 

90.5 

1901-1903 

487,008 

631 

129.6 

1888 

123,338 

89 

72.2 

1889 

126,268 

109 

86.3 

1907 

173,384 

174 

100.4 

1890 

129,197 

107 

82.8 

1908 

175,593 

211 

120.2 

IQOQ 

177,802 
180,011 

206 

115  9 

1886-1890 

616,689 
132,069 

515 
134 

83.5 
101.5 

1910 
1907-1910 

237 

131.7 

1891 

7*06,790 

828 

117.1 

1892 

134,941 

129 

95.6 

1893 

137,813 

108 

78.4 

1911 

182,220 

219 

120.2 

1894 

140,685 

122 

86.7 

1912 

184,429 

232 

125.8 

1895 

143,556 

143 

99.6 
92.3 

1913 

Source : 

186,638            269 
Annual  Reports  of  tl: 

144.1 

1891-1895 

689,064 

636 

le  Depart- 

ment  of  Public  Health  of  the  City  of  San 

1896 

146,428 

152 

103.8 

Francisco, 

Cal. 

1897 

149,300 

157 

105.2 

1898 

152,172 

191 

125.5 

1899 

155,044 

167 

107.7 

1900 

157,916 

190 

857 

120.3 
112.6 

1896-1900 

760,860 

Table  162 

Mortality  from  Cancer  in  San  Francisco,  Cal.,  by  Organs  and  Parts 

according  to  Sex,  July  1,  1906,  to  June  30,  1913 


TOTAL 

MALES 

FEMALES 

Organ  or  Part 

Deaths 

from 
Cancer 

Rate  per 

100,000 

Population 

Deaths 

from 

Cancer 

Rate  per 

100,000 

Population 

Deaths 

from 
Cancer 

Rate  per 

100,000 

Population 

Buccal  cavity 

186 

6.5 

172 

10.6 

14 

1.1 

1,377 
442 

48.0 
15.4 

878 
223 

54.1 
13.7 

499 
219 

40.1 

Peritoneum,  intestines,  rectum 

17.6 

Female  generative  organs 

406 

14.2 

406 

32.6 

Breast 

253 

8.8 

i 

o.i 

252 

20.2 

Skin 

67 

2.3 

41 

2.5 

26 

2.1 

Other  or  not  specified  organs  .  . 

468 
.3,199 

16.4 
111.6 

336 

20.8 
101.8 

132 

10.6 

All  organs 

1,651 

1,548 

124.3 

Source:     Annual  Reports  of  the  Department  of  Public  Health  of  the  City  of  San 
Francisco,  Cal. 


564 


APPENDIX  F  (PART  II) 

Table  163 

Mortality  from  Cancer  in  San  Francisco,  Cal.,  by  Age 

according  to  Sex,  July  1,  1906,  to  June  30,  1911 


Ages 


Population 


Undergo 281,185 

20-29 268,150 

30-39 247,825 

40-49 168,026 

50-59 98,620 

60  and  over 77,285 

Unknown 17,394 


MALES 

Deaths 
from 
Cancer 

5 

25 

69 

207 

300 

503 

3 


All  ages 1,158,485 


1,112 


Rate  per 

100,000 

Population 

1.8 

9.3 

27.8 

123.2 

304.2 

650.8 


96.0 


Population 

273,025 

199,150 

166,770 

112,899 

69,675 

64,985 

2,506 


FEMALES 
Deaths 
from 
Cancer 

2 

16 

119 

233 

276 

400 

1 


889,010         1,047 


Rate  per 

100,000 

Population 

0.7 

8.0 

71.4 

206.4 

396.1 

615.5 


117.8 


Source:     Annual  Reports  of  the  Department  of  Public  Health  of  the  City  of  San 
Francisco,  Cal. 

Table  164 

Mortality  from  Cancer  in  Savannah,  Ga. 

1881-1914 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1881 

31,957 

15 

46.9 

1901 

55,326 

17 

30.7 

1882 

33,205 

13 

39.2 

1902 

56,408 

33 

58.5 

1883 

34,453 

7 

20.3 

1903 

57,490 

19 

33.0 

1884 

35,701 

15 

42.0 

1904 

58,572 

36 

61.5 

1885 

36,949 

14 

37.9 
37.2 

1905 
1901-1905 

59,654 

40 

67.1 

1881-1885 

172,265 

64 

287,450 

145 

50.4 

1886 

38,197 

14 

36.7 

1906 

60,736 

27 

44.5 

1887 

39,445 

22 

55.8 

1907 

61,818 

36 

58.2 

1888 

40,693 

10 

24.6 

1908 

62,900 

29 

46.1 

1889 

41,941 

10 

23.8 

1909 

63,983 

33 

51.6 

1890 

43,189 

19 

44.0 
36.9 

1910 
1906-1910 

65,064 

23 

35.3 

1886-1890 

203,465 

75 

314,500 

148 

47.1 

1891 

44,294 

16 

36.1 

1911 

66,146 

45 

68.0 

1892 

45,399 

12 

26.4 

1912 

67,228 

52 

77.3 

1893 

46,504 

22 

47.3 

1913 

68,310 

43 

62.9 

1894 

47,609 

10 

21.0 

1914 

69,392 

42 

60.5 

1895 

48,714 

19 

39.0 
34.0 

Source:     Annual  Municipal  Reports  of 
the  City  of  Savannah,  Ga. 

1891-1895 

232,520 

79 

1896 

49,820 

20 

40.1 

1897 

50,926 

17 

33.4 

1898 

52,032 

25 

48.0 

1899 

53,138 

20 

37.6 

1900 

54,244 

22 

40.6 
40.0 

1896-1900 

260,160 

104 

565 


APPENDIX  F  {PART  II) 

Table  165 
Mortality  from  Cancer  in  Savannah,  Ga, 
1881-1914 


White 


Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Cancer 

Population 

1881 

15,558 

9 

57.8 

1882 

16,075 

10 

62.2 

1883 

16,592 

4 

24.1 

1884 

17,109 

9 

52.6 

1885 

17,626 

9 

51.1 

1881-1885 

82,960 

41 

49.4 

1886 

18,143 

11 

60.6 

1887 

18,660 

13 

69.7 

1888 

19,177 

8 

41.7 

1889 

19,694 

8 

40.6 

1890 

20,211 

9 

44.5 

1886-1890 

95.885 

49 

51.1 

1891 

20,800 

10 

48.1 

1892 

21,389 

6 

28.1 

1893 

21,979 

8 

36.4 

1894 

22,569 

5 

22.2 

1895 

23,159 

9 

38.9 

1891-1895 

109,896 

38 

34.6 

1896 

23.749 

14 

58.9 

1897 

24,339 

14 

5715 

1898 

24,929 

21 

84.2 

1899 

25,519 

16 

62.7 

1900 

26,109 

15 

57.5 

1896-1900 

124.645 

80 

64.2 

1901 

26,676 

16 

60.0 

1902 

27,243 

24 

88.1 

1903 

27,810 

15 

53.9 

1904 

28,377 

22 

77.5 

1905 

28,944 

24 

82.9 

1901-1905 

139,050 

101 

72.6 

1906 

29,512 

21 

71.2 

1907 

30,080 

25 

83.1 

1908 

30,648 

20 

65.3 

1909 

31.216 

25 

80.1 

1910 

31.784 

17 

53.5 

1906-1910 

153,240 

108 

70.5 

1911 

32,351 

29 

89.6 

1912 

32,918 

28 

85.1 

1913 

33.485 

24 

71.7 

1914 

34.052 

32 

94.0 

Source:     Annual    Municipal    Reports    of     the     City    of 
Savannah,  Ga. 


566 


APPENDIX  F  {PART  11) 

Table  166 

Mortality  from  Cancer  in  Savannah,  Ga.,  Colored 

1881-1914 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

16,399 

6 

36.6 

1901 

28,650 

1 

3.5 

1882 

17,130 

3 

17.5 

1902 

29,165 

9 

30.9 

1883 

17,861 

3 

16.8 

1903 

29,680 

4 

13.5 

1884 

18,592 

6 

32.3 

1904 

30,195 

14 

46.4 

1885 

19,323 
89,305 

5 

25.9 
25.8 

1905 
1901-1905 

30,710 

16 

52.1 

1881-1885 

23 

148,400 

44 

29.6 

1886 

20,054 

3 

15.0 

1906 

31,224 

6 

19.2 

1887 

20,785 

9 

43.3 

1907 

31,738 

11 

34.7 

1888 

21,516 

2 

9.3 

1908 

32,252 

9 

27.9 

1889 

22,247 

2 

9.0 

1909 

32,766 

8 

24.4 

1890 

22,978 
107,580 

10 

43.5 
24.2 

1910 

33,280 

6 

18.0 

26 

1886-1890 

1906-1910 

161,260 

40 

24.8 

1891 

23,494 

6 

25.5 

1892 

24,010 

6 

25.0 

1911 

33.795 

16 

47.3 

1893 

24,525 

14 

57.1 

1912 

34,310 

24 

70.0 

1894 

25,040 

5 

20.0 

1913 

34,825 

19 

54.6 

1895 

25,555 
122,624 

10 

39.1 
33.4 

1914 
Source: 

35,340 
Annual  M 

10 
iinicipal  I 

28.3 

1891-1895 

41 

eports  of 

the  City  of  Savannah, 

Ga. 

1896 

26,071 

6 

23.0 

1897 

26,587 

3 

11.3 

1898 

27,103 

4 

14.8 

1899 

27,619 

4 

14.5 

1900 

28,135 
135,515 

7 

24.9 
17.7 

1896-1900 

24 

Table  167 

Mortality  from  Cancer  in  Seattle,  Wash. 

1899-1914 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1899 

76,887 

26 

33.8 

1906 

174,583 

61 

34.9 

1900 

80,671 

31 

38.4 

1907 

190,235 

92 

48.4 

1908 

205,888 

93 

45.2 

1901 

96,323 

39 

40.5 

1909 

221,541 

130 

58.7 

1902 

111,975 

44 

.39.3 

1910 

237,194 

141 

59.4 

1903 
1904 

127,627 
143,279 

52 

51 

40.7 
35.6 

1906-1910 

1,029,441 

517 

50.2 

1905 

158,931 

55 

34.6 

1911 

252,847 
268,500 

144 

57  0 

1901-1905 

638,135 

241 

37.8 

1912 

154 

57.4 

1913 

284,153 

193 

67.9 

1914 

299,806 

210 

70.0 

Source: 

Annual  Reports  of  th 

e  Depart- 

ment  of  Health  and  Sanitation  o 

F  the  City 

of  Seattle,  Wash. 

567 


APPENDIX  F  (PART  II) 

Table  168 
Mortality  from  Cancer  in  Seattle,  Wash.,  by  Organs  and  Parts 

1901-1912 

Deaths  Rate  per 

Organ  or  Part  from  100,000 

Cancer  Population 

Buccal  ca\aty 45  2.1 

Stomach  and  liver 421  19.2 

Peritoneum,  intestines  and  rectum 133  6.1 

Female  generative  organs 192  8.8 

Breast 74  8.4 

Skin 24  1.1 

Other  or  not  specified  organs 167  7.5 

All  organs 1,056  48.2 

Source:     Annual  Reports  of  the  Department  of  Health  and  Sanitation  of  the  City  of 
Seattle,  Wash. 

Table  169 

Mortality  from  Cancer  in  Springfield,  Mass. 

1890-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1890 

44,179 

24 

54.3 

1901 

64,745 

40 

61.8 

1902 

67,431 

57 

84.5 

1891 

45,967 

26 

56.6 

1903 

70,117 

60 

85.6 

1892 

47,755 

25 

52.4 

1904 

72,804 

69 

94.8 

1893 

49,543 

24 

48.4 

1905 

75,491 

74 

98.0 

1894 

51,331 

27 

52.6 

1895 

53,119 

32 

60.2 
54.1 

1901-1905 
1906 

350,588 

78,178 

300 
66 

85.6 

1891-1895 

247,715 

134 

84.4 

1907 

80,865 

64 

79.1 

1896 

54,907 

36 

65.6 

1908 

83,552 

84 

100.5 

1897 

56,695 

45 

79.4 

1909 

86,239 

65 

75.4 

1898 

58,483 

45 

76.9 

1910 

88,926 

84 

94.5 

1899 

60,271 

42 

69.7 

1900 

62,059 

48 

77.3 
73.9 

1906-1910 
1911 

417,760 
91,613 

363 

82 

86.9 

1896-1900 

292,415 

216 

89.5 

1912 

94,300 

92 

97.6 

1913 

96,987 

109 

112.4 

Source: 

Municipal  Register  of  the  City 

of  Springfield,  Mass. 

568 


APPENDIX  F  (PART  II) 

Table  170 
Mortality  from  Cancer  in  Springfield,  Mass. 
1891-1913 


Males 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1891 

22,123 

8 

36.2 

1901 

30,976 

9 

29.1 

1892 

22,955 

9 

39.2 

1902 

32,336 

14 

43.3 

1893 

23,787 

4 

16.8 

1903 

33,696 

16 

47.5 

1894 

24,619 

8 

32.5 

1904 

35,056 

12 

34.2 

1895 

25,451 

7 

27.5 
30.3 

1905 
1901-1905 

36,416 

26 

71.4 

1891-1895 

118,935 

36 

168,480 

77 

45.7 

1896 

26,284 

9 

34.2 

1906 

37,777 

21 

55.6 

1897 

27,117 

13 

47.9 

1907 

39,138 

22 

56.2 

1898 

27,950 

10 

35.8 

1908 

40,499 

33 

81.5 

1899 

28,783 

12 

41.7 

1909 

41,860 

24 

57.3 

1900 

29,616 

9 

30.4 
37.9 

1910 
1906-1910 

43,221 

29 

67.1 

1896-1900 

139,750 

63 

202,495 

129 

63.7 

1911 

44,582 

26 

58.3 

1912 

,   45,943 

28 

60.9 

1913 

47,304 

40 

84.6 

Source: 

Municipal  Register  of  the  City- 

of  Springfield,  Mass. 

Table  171 
Mortality  from  Cancer  in  Springfield,  Mass. 
1891-1913 


Females 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1891 

23,844 

18 

75.5 

1901 

33,769 

31 

91.8 

1892 

24,800 

16 

64.5 

1902 

35,095 

43 

122.5 

1893 

25,756 

20 

77.7 

1903 

36,421 

44 

120.8 

1894 

26,712 

19 

71.1 

1904 

37,748 

57 

151.0 

1895 

27,668 

25 

90.4 
76.1 

1905 
1901-1905 

39,075 

48 

122.8 

1891-1895 

128,780 

98 

182,108 

223 

122.5 

1896 

28,623 

27 

94.3 

1906 

40,401 

45 

111.4 

1897 

29,578 

32 

108.2 

1907 

41,727 

42 

100.7 

1898 

30,533 

35 

114.6 

1908 

43,053 

51 

118.5 

1899 

31,488 

30 

95.3 

1909 

44,379 

41 

92.4 

1900 

32,443 

39 

120.2 
106.8 

1910 
1906-1910 

45,705 

55 

120.3 

1896-1900 

152,665 

163 

215,265 

234 

108.7 

1911 

47,031 

56 

119.1 

1912 

48,357 

64 

132.3 

1913 

49,683 

69 

138.9 

Source:   Municipal  Register  of  the  City 
of  Springfield,  Mass. 

569 


APPENDIX  F  {PART  II) 

Table  172 

Mortality  from  Cancer  in  Springfield,  Mass.,  by  Organs  and  Parts 
according  to  Sex,  1908-1912 


TOTAL 


Organ  or  Part 

Buccal  cavity 

Stomach  and  liver 

Peritoneum,  intestines,  rectum 

Female  generative  organs 

Breast 

Skin 

Other  or  not  specified  organs  . . 


Deaths 
from 
Cancer 

14 
132 
71 
64 
46 
13 
67 


Rate  per 

100,000 

Population 

3.1 
29.7 
16.0 
14.4 
10.3 

2.9 
15.1 


MALES 
Deaths        Rate  per 


from 
Cancer 

12 
55 
33 


8 

32 


100,000 
Population 

5.6 
25.5 
15.3 


3.7 
14.7 


All  organs 407  91.5  140  64.8 

Source:    Municipal  Register  of  the  City  of  Springfield,  Mass. 


FEMALES 
Deaths       Rate  per 
100,000 
Population 

0.9 


from 
Cancer 


2 
77 
38 
64 
46 

5 
35 


267 


33.7 
16.6 
28.0 
20.1 
2.2 
15.3 

116.8 


Table  173 

Mortality  from  Cancer  in  St.  Louis,  Mo. 

1881-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

359,631 

158 

43.9 

1901 

586,417 

345 

58.8 

1882 

368,981 

126 

34.1 

1902 

597,596 

356 

59.6 

1883 

378,575 

178 

47.0 

1903 

608,775 

392 

64.4 

1884 

388,418 

171 

44.0 

1904 

619,954 

374 

60.3 

1885 

398,517 

152 

38.1 
41.4 

1905 
1901-1905 

631,133 

419 

66.4 

1881-1885 

1,894,122 

785 

3,043,875 

1,886 

62.0 

1886 

408,878 

149 

36.4 

1906 

642,312 

443 

69.0 

1887 

419,509 

164 

39.1 

1907 

653,491 

479 

73.3 

1888 

429,390 

170 

39.6 

1908 

664,670 

548 

82.4 

1889 

440,554 

189 

42.9 

1909 

675,849 

569 

84.2 

1890 

451,770 

263 

58.2 
43.5 

1910 
1906-1910 

687,029 

568 

82.7 

1886-1890 

2,150,101 

935 

3,323,351 

2,607 

78.4 

1891 

462,816 

275 

59.4 

1911 

698,208 

526 

75.3 

1892 

474,132 

248 

52.3 

1912 

709,387 

604 

85.1 

1893 

485,725 

243 

50.0 

1913 

720,566 

682 

94.6 

1894 

497,601 

224 

45.0 

1895 

509,707 

268 

52.6 

Source: 

Annual  and  Monthly  Reports 

of  tViP  TTealtli  nf.r>nrtmpnt  nf  .^t    T.niiis    Mn 

1891-1895 

2,429,981 

1,258 

51.8 

1896 

522,209 

268 

51.3 

1897 

534,977 

266 

49.7 

1898 

548,057 

304 

55.5 

1899 

561,4.56 

297 

52.9 

1900 

575,238 

345 

60.0 
54.0 

1896-1900 

2,741,937 

1,480 

570 


APPENDIX  F  {PART  II) 

Table  174 

Mortality  from  Cancer  in  St.  Louis,  Mo.,  Males 

1887-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1887 

212,691 

71 

33.4 

1901 

293,912 

151 

51.4 

1888 

217,400 

74 

34.0 

1902 

299,635 

150 

50.1 

1889 

222,744 

77 

34.6 

1903 

305,362 

182 

59.6 

1890 

228,099 

127 

55.7 

1904 

311,155 

161 

51.7 

1905 

316,955 

162 

51.1 

1887-1890 

880,934 

349 

39.6 

1901-1905 

1,527,019 

806 

52.8 

1891 

233,491 

115 

49.3 

1892 

239,010 

106 

44.3 

1906 

322,762 

218 

66.0 

1893 

244,660 

86 

35.2 

1907 

328,575 

202 

61.5 

1894 

250,443 

100 

39.9 

1908 

334,395 

229 

68.5 

1895 

256,332 

111 

43.3 

1909 

340,222 

246 

72.3 

1910 

346,057 

248 

71.7 

1891-1895 

1,223,936 

518 

42.3 

1906-1910 

1,672,011 

1,138 

68.1 

1896 

262,410 

116 

44.2 

1897 

268,612 

108 

40.2 

1911 

351,897 

213 

60.5 

1898 

274,960 

137 

49.8 

1912 

357,744 

260 

72.7 

1899 

281,458 

127 

45.1 

1913 

363,588 

325 

89.4 

1900 

288,194 

117 

40.6 

Source: 

Annual  and 

Monthly  Reports 

1896-1900 

1,375,634 

605 

44.0 

of  the  Health  Department  of  St.  Louis,  Mo. 

Table  175 

Mortality  from  Cancer  in  St,  Louis  Mo.,  Females 

1887-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1887 

206,818 

93 

45.0 

1901 

292,505 

194 

66.3 

1888 

211,990 

96 

45.3 

1902 

297,961 

206 

69.1 

1889 

217,810 

112 

51.4 

1903 

303,413 

210 

69.2 

1890 

223,671 

136 

60.8 

1904 

308,799 

213 

69.0 

1905 

314,178 

257 

81.8 

1887-1890 

860,289 

437 

50.8 

1901-1905 

1,516,856 

1,080 

71.2 

1891 

229,325 

160 

69.8 

1892 

235,122 

142 

60.4 

1906 

319,550 

230 

72.0 

1893 

241,065 

157 

65.1 

1907 

324,916 

277 

85.3 

1894 

247,158 

124 

50.2 

1908 

330,275 

319 

96.6 

1895 

253,375 

157 

62.0 

1909 

335,627 

323 

96.2 

1910 

340,972 

320 

93.8 

1891-1895 

1,206,045 

740 

61.4 

1906-1910 

1,651,340 

1,469 

89.0 

1896 

259,799 

152 

58.5 

1897 

266,365 

158 

59.3 

1911 

346,311 

313 

90.4 

1898 

273,097 

167 

61.2 

1912 

351,643 

344 

97.8 

1899 

279,998 

170 

60.7 

1913 

356,978 

357 

100.0 

1900 

287,044 

228 

79.4 

Source: 

Annual  and 

Monthly  Reports 

1896-1900 

1,366,303 

875 

64.0 

of  the  Health  Department  of  St.  Louis,  Mo. 

571 


APPENDIX  F  {PART  II) 

Table  176 

Mortality  from  Cancer  in  St.  Paul,  Minn. 

1885-1913 


Year 

Deaths 

Rate  per 

(Ending 

Population 

from 

100,000 

October  31) 

Cancer 

Population 

1885 

74,305 

36 

48.4 

1886 

83,497 

29 

34.7 

(Calendar) 

1887 

93,826 

23 

24.5 

1888 

1889 

118,474 

39 

32.9 

1890 

133,156 

45 

33.8 

1886-1890 

428,953 

136 

31.7 

1891 

134,583 

62 

46.1 

1892 

136,010 

62 

45.6 

1893 

137,437 

58 

42.2 

1894 

138,864 

51 

36.7 

1895 

140,292 

67 

47.8 

1891-1895 

687,186 

300- 

43.7 

1896 

144,846 

67 

46.3 

1897 

149,400 

52 

34.8 

1898 

153,955 

74 

48.1 

1899 

158,510 

66 

41.6 

1900 

163,065 

92 

56.4 

1896-1900 

769,776 

351 

45.^ 

1901 

169,856 

60 

35.3 

1902 

176,647 

83 

47.0 

1903 

183,439 

107 

58.3 

1904 

190,231 

115 

60.5 

1905 

197,023 

115 

58.4 

1901-1905 

917,196 

480 

52.3 

1906 

200,567 

121 

60.3 

1907 

204,111 

135 

66.1 

1908 

207,655 

159 

76.6 

1909 

211,199 

143 

67.7 

1910 

214,744 

180 

83.8 

1906-1910 

1,038,276 

738 

71.1 

1911 

218,288 

160 

73.3 

1912 

221,832 

160 

72.1 

1913 

225,376 

187 

83.0 

Source:     Annual  Reports  of  the  Board  of  Health  of  the 
City  of  St.  Paul,  Minn. 


672 


APPENDIX  F  (PART  II) 

Table  177 

Mortality  from  Cancer  in  District  of  Columbia 

1879-1914 


Year 

Deaths 

Rate  per 

Deaths 

Rate  per 

(Ending 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

June  30) 

Cancer 

PopulatioQ 

Cancer       Population 

1879 

171,919 

94 

54.7 

1901 

283,953 

194 

68.3 

1880 

177,624 

78 

43.9 

1902 

289,188 

218 

75.4 

1903 

294,423 

220 

74.7 

1881 

182,900 

87 

47.6 

1904 

299,658 

228 

76.1 

1882 

188,176 

80 

42.5 

1905 

304,893 

231 

75.8 

1883 

193,453 

77 

39.8 

1884 

198,730 

88 

44.3 

1901-1905 

1,472,115 

1,091 

74.1 

1885 

204,007 

119 

58.3 

1906 

310,128 

253 

81.6 

1881-1885 

967,266 

451 

46.6 

1907 

315,363 

280 

88.8 

1908 

320,598 

275 

85.8 

1886 

209,284 

101 

48.3 

1909 

325,833 

278 

85.3 

1887 

214,561 

112 

52.2 

1910 

331,069 

293 

88.5 

1888 

219,838 

103 

46.9 

1889 

225,115 

118 

52.4 

1906-1910 

1,602,991 

1,379 

86.0 

1890 

230,392 

121 

52.5 

1911 

336,305 

286 

85.0 

1886-1890 

1,099,190 

555 

50.5 

1912 

341,541 

323 

94.6 

1913 

346,777 

351 

101.2 

1891 

235,224 

131 

55.7 

1914 

352,015 

344 

97.7 

1892 

240,056 

111 

46.2 

1893 

244,888 

152 

62.1 

Source: 

Annual  Reports  of  the  Health 

1894 

249,720 

130 

52.1 

Officer  of  the  District  of  Columbia 

1895 

254,553 

140 

55.0 
54.2 

Note: 

1902-1914,  Calendar  Ye 

ars. 

1891-1895 

1,224,441 

664 

1896 

259,386 

155 

59.8 

1897 

264,219 

144 

54.5 

1898 

269,052 

160 

59.5 

1899 

273,885 

177 

64.6 

1900 

278,718 

204 

73.2 
62.4 

1896-1900 

1,345,260 

840 

573 


APPENDIX  F  {PART  II) 

Table  178 

Mortality  from  Cancer  in  District  of  Columbia,  Males 

1879-1913 


Year 

Deaths 

Rate  per 

Deaths 

Rate  per 

(En.Iin? 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

June3U) 

Cancer 

Population 

Cancer 

Population 

1879 

80,842 

18 

22.3 

1901 

134,608 

65 

48.3 

1880 

83,578 

28 

33.5 

1902 

137,212 

77 

56.1 

1903 

139,816 

70 

50.1 

1882 

88,778 

29 

32.7 

1904 

142,420 

79 

55.5 

1883 

91,378 

24 

26.3 

1905 

145,025 

82 

56.5 

1884 

93,978 

26 

27.7 

1885 

96,579 

35 

36.2 
30.8 

1901-1905 
1906 

699,081 
147,630 

373 
105 

53.4 

1882-1885 

370,713 

114 

71.1 

1907 

150,235 

94 

62.6 

1886 

99,180 

30 

30.2 

1908 

152,840 

100 

65.4 

1887 

101,781 

33 

32.4 

1909 

155,445 

111 

71.4 

1888 

104,382 

32 

30.7 

1910 

158,050 

116 

73.4 

1889 

106,983 

28 

26.2 

1890 

109,584 

32 
155 

29.2 
29.7 

1906-1910 
1911 

764,200 
160,655 

526 

108 

68.8 

1886-1890 

521,910 

67.2 

1912 

163,260 

127 

77.8 

1891 

111,826 

41 

36.7 

1913 

165,865 

137 

82.6 

1892 

114,068 

41 

35.9 

1893 

116,310 

50 

43.0 

Source: 

Annual  Reports  of  the  Health 

1894 

118,552 

59 

49.8 

Officer  of  the  District  of  Columbia. 

1895 

120,794 

45 

37.3 
40.6 

Note: 

1902-1913,  Calendar  Y 

ears. 

1891-1895 

581,550 

236 

1896 

123,036 

41 

33.3 

1897 

125,278 

51 

40.7 

1898 

127,520 

51 

40.0 

1899 

129,762 

58 

44.7 

1900 

132,004 

70 

53.0 
42.5 

1896-1900 

637,600 

271 

574 


APPENDIX  F  (PART  11) 

Table  179 

Mortality  from  Cancer  in  District  of  Columbia,  Females 

1879-1913 


Year 

Deaths 

Rate  per 

Deaths 

Rate  per 

(Ending 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

June  30) 

Cancer 

Population 

Cancer 

Population 

1879 

91,077 

76 

83.4 

1901 

149,345 

129 

86.4 

1880 

94,046 

50 

53.2 

1902 

151,976 

141 

92.8 

1903 

154,607 

150 

97.0 

1882 

99,398 

51 

51.3 

1904 

157,238 

149 

94.8 

1883 

102,075 

53 

51.9 

1905 

159,868 

149 

93.2 

1884 

104,752 

62 

59.2 

1885 

107,428 

84 

78.2 
60.4 

1901-1905 
1906 

773,034 
162,498 

718 
148 

92.9 

1882-1885 

413,653 

250 

91.1 

1907 

165,128 

186 

112.6 

1886 

110,104 

71 

64.5 

1908 

167,758 

175 

104.3 

1887 

112,780 

79 

70.0 

1909 

170,388 

167 

98.0 

1888 

115,456 

71 

61.5 

1910 

173,019 

177 

102.3 

1889 

118,132 

90 

76.2 

1890 

120,808 

89 

73.7 
69.3 

1906-1910 
1911 

838,791 
175,650 

853 
178 

101.7 

1886-1890 

577,280 

400 

101.3 

1912 

178,281 

196 

109.9 

1891 

123,398 

90 

72.9 

1913 

180,912 

214 

118.3 

1892 

125,988 

70 

55.6 

1893 

128,578 

102 

79.3 

Source: 

Annual  Reports  of  tl 

e  Health 

1894 

131,168 

71 

54.1 

Oflacer  of  the  District  of  Columbia. 

1895 

133,759 

95 

71.0 
66.6 

Note: 

1902-1913,  Calendar  Y 

ears. 

1891-1895 

642,891 

428 

1896 

136,350 

114 

83.6 

1897 

138,941 

93 

66.9 

1898 

141,532 

109 

77.0 

1899 

144,123 

119 

82.6 

1900 

146,714 

134 

91.3 
80.4 

1896-1900 

707,660 

569 

38 


575 


APPENDIX  F  {PART  II) 

Table  180 

Mortality  from  Cancer  in  District  of  Columbia,  White 

1882-1914 


Year 

Deaths 

Rate  per 

Deaths 

Rate  per 

(Ending 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

June  30) 

Cancer 

Population 

Cancer 

Population 

1882 

125,343 

55 

43.9 

1901 

195,991 

137 

69.9 

1883 

129,012 

51 

39.5 

1902 

200,450 

173 

86.3 

1884 

132,681 

64 

48.2 

1903 

204,909 

162 

79.1 

1885 

136,350 

86 

63.1 

1904 

209,368 

173 

82.6 

1905 

213,828 

179 

83.7 

1882-1885 

523,386 

256 

48.9 

1901-1905 

1,024,546 

824 

80.4 

1886 

140,019 

78 

55.7 

1887 

143,688 

78 

54.3 

1906 

218,288 

188 

86.1 

1888 

147,357 

77 

52.3 

1907 

222,748 

219 

98.3 

1889 

151,026 

98 

64.9 

1908 

227,208 

206 

90.7 

1890 

154,695 

92 

59.5 

1909 

231,668 

209 

90.2 

1910 

236,128 

239 

iOl.2 

1886-1890 

736,785 

423 

57.4 

1906-1910 

1,136,040 

1,061 

93.4 

1891 

158,378 

90 

56.8 

1892 

162,061 

87 

53.7 

1911 

240,587 

215 

89.4 

1893 

165,744 

116 

70.0 

1912 

245,046 

245 

100.0 

1894 

169,428 

98 

57.8 

1913 

249,508 

278 

111.4 

1895 

173,112 

111 

64.1 
60.6 

1914 
Source: 

253,970            259 
Annual  Reports  of  th 

102.0 

1891-1895 

828,723 

502 

e  Health 

Officer  of  the  District  of  Columbia 

1896 

176,796 

115 

65.0 

Note: 

1902-1914,  Calendar  Years. 

1897 

180,480 

98 

54.3 

1898 

184,164 

118 

64.1 

' 

1899 

187,848 

126 

67.1 

1900 

191,532 

145 

75.7 
65.4 

1896-1900 

920,820 

602 

576 


APPENDIX  F  {PART  II) 

Table  181 

Mortality  from  Cancer  in  District  of  Columbia,  Colored 

1882-1914 


Year 

Deaths 

Rate  per 

Deaths 

Rate  per 

(Ending 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

June  30) 

Cancer 

Population 

Cancer       Population 

1882 

62,833 

25 

39.8 

1901 

87,962 

57 

64.8 

1883 

64,441 

26 

40.3 

1902 

88,738 

45 

50.7 

1884 

66,049 

24 

36.3 

1903 

89,514 

58 

64.8 

1885 

67,657 

33 

48.8 

1904 

90,290 

55 

60.9 

1905 

91,065 

52 

67.1 

1882-1885 

260,980 

108 

41.4 

1901-1905 

447,569 

267 

59.7 

1886 

69,265 

23 

33.2 

1887 

70,873 

34 

48.0 

1906 

91,840 

65 

70.8 

1888 

72,481 

26 

35.9 

1907 

92,615 

61 

65.9 

1889 

74,089 

20 

27.0 

1908 

93,390 

69 

73.9 

1890 

75,697 

29 

38.3 

1909 

94,165 

69 

73.3 

1910 

94,941 

54 

56.9 

1886-1890 

362,405 

132 

36.4 

1906-1910 

466,951 

318 

68.1 

1891 

76,846 

41 

53.4 

1892 

77,995 

24 

30.8 

1911 

95,718 

71 

74.2 

1893 

79,144 

36 

45.5 

1912 

96,494 

78 

80.8 

1894 

80,292 

32 

39.9 

1913 

97,269 

73 

75.0 

1895 

81,441 

29 

35.6 
40.9 

1914 
Source: 

98,045              85 
Annual  Reports  of  the 

86.7 

1891-1895 

395,718 

162 

Health 

Officer  of  the  District  of  Columbia 

1896 

82,590 

40 

48.4 

Note: 

1902-1914,  Calendar  Years. 

1897 

83,739 

46 

54.9 

1898 

84,888 

42 

49.5 

1899 

86,037 

61 

59.3 

1900 

87,186 

59 

67.7 
56.1 

1896-1900 

424,440 

238 

577 


APPENDIX  F  {PART  II) 

Table  182 

Mortality  from  Cancer,  by  Organs  and  Parts,  in  the  District  of  Columbia 

according  to  Age,  White  Males,  1901-1910 


Bdccal 

Cavity 

Stomach 

AND  Liver 

Deaths 

from 
Cancer 

Rate  per 

100,000 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

JnderlO 

0.6 

1 

10-19 

1 

0.6 

20-29 

3 

1.4 

30-39 

2 

1.1 

18 

9.7 

40-49 

4 

3.0 

38 

28.3 

50-59 

17 

19.0 

80 

89.5 

60-69 

13 

23.0 

125 

221.0 

70  and  over 

12 

37.0 

87 

268.3 

All  ages 

49 

4.6 

352 

33.4 

40  and  over 

46 

14.7 

330 

105.5 

Peritoneum 

Intestines  and  Rectum 

Skin 

Under  10 

1 

0.6 

1.8 

10-19 

3 

20-29 

3 

1.4 
6.5 

1 

0.5 

30-39 

12 

40-49 

15 

11.2 

3 

2.2 

50-59 

21 

23.5 

11 

12.3 

60-69 

32 

56.6 

15 

26.5 

70  and  over 

21 

64.8 

18 

55.5 

All  ages 

108 

10.2 

48 

4.6 

89 

28.5 
r  Specified 

NS 

47 
All  Orga 

15.0 

Other  or  No 
Orga 

vs  AND  Parts 

Under  10 

2 

1.1 

1.2 

3 

7 

1.7 

10-19 :. 

2 

4.2 

20-29 

5 

2.4 

12 

5.8 

30-39 

11 

5.9 
17.9 

43 

84 

23.2 

40-49 

24 

62.5 

50-59 

34 

38.1 

163 

182.4 

60-69 

49 

86.6 

234 

413.7 

70  and  over 

60 

185.0 
17.7 

198 

744 

610.6 

All  ages 

187 

70.6 

40  and  over 

167 

53.4 

679 

217.1 

578 


APPENDIX  F  {PART  II) 

Table  183 

Mortality  from  Cancer,  by  Organs  and  Parts,  in  the  District  of  Columbia 

according  to  Age,  White  Females,  1901-1910 


Under  10. 
10-19.... 
20-29.... 
30-39.... 
40-49.... 
50-59.... 
60-69.... 


70  and  over. 


All  ages.  . .  . 
40  and  over. 


Under  10. 
10-19.... 
20-29.... 
30-39. . . . 
40-49.... 
50-59. . . . 
60-69. . . . 


70  and  over. 


Aliases 331 

40  and  over 


Buccal  Cavity 

Stomach  and  Liveb 

Peritoneum 
Intestines  and  Rectum 

Deaths 

from 

Cancer 

Rate  per 

100,000 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

i 

0.4 

2 

0.9 

i 

0.4 

17 

8.7 

11 

5.6 

2 

1.4 

44 

31.3 

24 

17.1 

83 

87.6 

45 

47.5 

6 

9.5 

96 

151.6 

33 

52.1 

3 

8.6 

59 

168.5 

23 

65.7 

12 

1.1 

301 

27.1 

137 

12.4 

11 

3.3 

282 

84.5 

125 

37.5 

Fem.ale 
Genebative  Organs 

Breast 

& 

KLN 

Deaths 

from 

Cancer 

Rate  per 

100,000 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1 

0.6 

i 

0.6 

49 

24.9 

16 

8.i 

1 

0.5 

88 

62.6 

48 

34.1 

2 

1.4 

101 

106.6 

63 

66.5 

3 

3.2 

59 

93.2 

55 

86.9 

6 

9.5 

33 

94.2 

43 

122.8 

12 

34.3 

331 

29.9 

225 

20.3 

25 

2.3 

281 

84.2 

209 

62.6 

23 

6.9 

Other  or  Not 
Specified  Organs 

Deaths  Rate  per 

from  100,000 

Cancer  Population 

Under  10 1  0.6 

10-19 1  0.6 

20-29 3  1.3 

30-39 16  8.1 

40-49 20  14.2 

50-59 34  35.9 

60-69 34  53.7 

70  and  over 22  62.8 

Allages 131  11.8 

40  and  over 110  33.0 


All  Organs  and  Parts 
Deaths  Rate  per 


from 
Cancer 

1 

3 

7 
110 

228 
329 
289 
195 

1,162 
1,041 


100,000 
Population 

0.6 

1.7 

3.1 
56.0 
162.2 
347.3 
456.4 
556.9 

104.8 
312.0 


579 


APPENDIX  F  {PART  II) 

Table  184 

Mortality  from  Cancer,  by  Organs  and  Parts,  in  the  District  of  Columbia 

according  to  Age,  Colored  Males,  1901-1910 


Under  10.... 

10-19 

20-29 

30-39 

40-49 

50-59 

60-69 

70  and  over . 

All  ages . . . . . 
40  and  over. . 


Under  10 

10-19 

20-29 

30-39 

40-49 

50-59 

60-69 

70  and  over . 

All  ages 

40  and  over. . 


3.2 


0.2 
1.0 


Buccal  Cavity 

Stomach 

AND  Liver 

Deaths 

from 
Cancer 

Rate  per 

100,000 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

3 

3.2 

1 

1.4 

11 

15.2 

2 

4.1 

15 

30.5 

2 

6.5 

26 

•    84.4 

3 

22.7 

22 

166.4 

5 

76.2 

10 

152.3 

13 

3.2 

87 

21.3 

12 

12.0 

73 

73.1 

Breast 

Skin 

Deaths 

from 

Cancer 

Rate  per 

100,000 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

2.2 
2.8 
2.0 
6.5 
15.1 


5.0 


All  Organs 

Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

Under  10 

10-19 

20-29 

....       9 

9.7 

30-39 

....     19 

26.3 

40-49 

....     24 

48.7 

50-59 

. . . .     43 

139.6 

60-69 

. . . .     41 

310.1 

70  and  over .... 

. . . .     22 

335.1 

All  ages 

158 

38.6 

40  and  over 

....   130 

130.2 

Peritoneum 

Intestines  and  Rectum 

Deaths         Rate  per 

from  100,000 

Cancer        Population 


1 

2.0 

5 

16.2 

5 

37.8 

3 

45.7 

16 

3.9 

14 

14.0 

Other  Organs 

Deaths  Rate  per 
from  100,000 

Cancer  Population 


25 


2.2 

6.9 

10.2 

22.7 
68.1 
60.9 

7.8 
25.0 


580 


APPENDIX  F  {PART  II) 

Table  185 

Mortality  from  Cancer,  by  Organs  and  Parts,  in  the  District  of  Columbia 

according  to  Age,  Colored  Females,  1901-1910 


1 

Pehitoneum 

BuccAii  Cavity 

Stomach  and  Liver     | 

Intestines  and  Rectom 

Deaths 

Rate  per 

Deaths 

Rate  per 

Deaths 

Rate  per 

from 

100,000 

from 

100,000 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

Cancer 

Population 

Under  10 

i 

0.8 

4 

3.i 

i 

2 

10-19 

1.1 

20-29 

1.5 

30-39 

2 

2.3 

10 

11.3 

5 

5.6 

40-49 

2 

3.4 

16 

27.4 

7 

12.0 

50-59 

2 

5.9 

31 

91.0 

12 

35.2 

60-69 

3 

17.6 

14 

82.0 

3 

17.6 

70  and  over. 

3 

30.1 

16 

160.6 

4 

40.2 

All  ages 

13 

2.6 

91 

18.1 

34 

6.8 

40  and  over . . 

10            8.4 

Female 

77 

64.5 

26 

21.8 

Generative  Ohgans 

Breast 

Skin 

Deaths 

Rata  per 

Deaths 

Rate  per 

Deaths 

Rate  per 

from 

100,000 

from 

100,000 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

Cancer 

Population 

Under  10 

1 

1.3 

10-19 

20-29 

6 

4.6 

3 

2.3 

30-39 

34 

38.4 

9 

10.2 

i 

i.i 

40-49 

65 

111.4 

21 

36.0 

50-59 

42 

123.3 

15 

44.1 

60-69 

25 

146.5 

15 

87.9 

70  and  over 

15 

150.6 

10 

100.4 

All  ages 

188 

37.4 

73 

14.5 

1 

0.2 

40  and  over. 

147 

123.1 

Othe 

61 

B  Organs 

51.1 

Ai 

ji  Organs 

Deaths 

Rate  per 

Death 

3          Rate  per 

from 

100,000 

from 

100,000 

Cancer 

Population 

Cance 

r        Population 

Under  1 
10-19.. 

0 

1 

1.3 

2 
1 

2.7 
1.1 

' 

20-29.. 

1 

0.8 

17 

13.1 

30-39.. 

3 

3.4 

64 

72.3 

40-49. . 

10 

17.1 

121 

207.3 

50-59.. 

10 

29.4 

112 

328.9 

60-69.. 

6 

35.1 

66 

386.6 

70  and 

over.  . . 

4 

40.2 

52 

522.1 

All  ages 

35 

7.0 

435 

86.5 

40  and  over. . . . 

30 

25.1 

351 

293.9 

Note:     Tables  182-185  are  from  the  same  source  as  Tables  177-181,  but  data  are  for 
Calendar  Years. 


581 


APPE>"DIX 


G 


Cancer  Mortality  Statistics  of  Foreign  Countries 


Table  Country  Period  Title  Page 

1  CmLizED  World 1908-1912 Persons 593 

2  Peixctpal  Countries 1901-1905—1906-1910  Persons 593 

3  Selected  Coxtn-tries 1908-1912 Crude  and  Standard- 

ized Rates 593 

i     Europe By  Countries 594 

5  Countries  of  Europe 1896-1910 Comparative      State- 

ment       595 

6  England  and  Wales 1881-1913 Persons 596 

7  "  "     1881-1913 Males 596 

8  "  "     1881-1913 Females 597 

9  "  "     1901-1910 By  Age  and  Sex 597 

10  "  "     1908-1912 By  Organs  and  Parts. 

according  to  Sex 598 

11  "  "     1897-1900— 1901-1910  Bv  Organs  and  Parts, 

Males 599 

12  "  "     1897-1900—1901-1910  By  Organs  and  Parts, 

Females 600 

13  "  "     1901-1910 Relative  Mortality,  by 

Organs  and  Parts,  ac- 
cording to  Sex 601 

14  "  "     1903-1912 FemaleBreast 601 

15  "  "     1911-1912 Urban  and  Rural,  by 

Organs  and  Parts,  ac- 
cording to  Sex 602 

15a         "  "      1911-1913 Cancer  of  the  Ovarj', 

by  Age  and  Conjugal 
Condition 603 

15b         "  "      1911-1913 Cancer  of  the  Uterus, 

by  Age  and  Conjugal 
Condition 603 

15c         "  " 1911-1913 Cancer  of  the  Breast, 

by  Age  and  Conjugal 
Condition 60-1 

15d  London 1649-1758 Cancer,    Fistula    and 

Gangrene 604 

16  "       1881-1913 Persons 605 

17  "        1881-1913 Males 605 

18  "       1881-1913 Females 606 

19  SheflBeld 1887-1913 Persons 607 

582 


APPENDIX  G 

Table                               Country                                    Period                                                       Title  Page 
England  and  Wales  {coiilinued) 

20  Sheffield 1887-1913 Males 607 

21  "        1887-1913 Females 608 

22  Liverpool 1889-1913 Persons 608 

23  "        1889-1913 Males 609 

24  "        1889-1913 Females 609 

25  Birmingham 1891-1912 Persons 610 

26  "           1904-1912 By  Sex 610 

27  Leeds 1893-1913 Persons 611 

28  Bristol 1894-1913 Persons 611 

29  Manchester 1891-1912 Persons 612 

30  "          1891-1912 Males 612 

31  "          1891-1912 Females 613 

32  Scotland 1881-1912 Persons 613 

33  "        1906-1912 By  Sex 614 

34  "        1906-1910 By  Organs  and  Parts, 

according  to  Sex. .....  614 

35  "        1906-1910 Relative  Mortality,  by 

Organs  and  Parts,  ac- 
cording to  Sex 615 

36  Aberdeen 1899-1913 Persons 615 

37  Edinburgh 1898-1913 Persons 616 

38  "          1898-1913 Males 616 

39  "         1898-1913 Females 617 

40  Glasgow 1881-1913 Persons 617 

41  Ireland 1881-1912 Persons 618 

42  "       1893-1912 Males 619 

43  "       1893-1912 Females 619 

44  "      1901-1910 By      Provinces     and 

Counties 620 

45  "       1901-1910 By  Organs  and  Parts, 

according  to  Sex 621 

46  "       1901-1910 By  Age  and  Sex 622 

47  "      , 1901 By  Organs  and  Parts 

and  Duration  of  Ill- 
ness, Males   623 

48  "       1901 By  Organs  and  Parts 

and  Duration  of  Ill- 
ness, Females 624 

49  Dubhn 1901-1912 Persons 625 

50  Belfast 1901-1912 Persons 625 

51  Isle  of  Man 1902-1913 Persons 626 

52  "          1902-1913 Males 626 

53  "          1902-1913 Females 627 

54  Guernsey,  Channel  Islands 1900-1913 Persons 627 

55  Gibraltar 1900-1913 Persons 628 

56  Malta  and  Gozo 1896-1912 Persons 628 

57  "  "     1911-1913 By  Organs  and  Parts, 

according  to  Sex 629 

58  Norway 1881-1912 Persons 629 

59  "       1896-1912 Males 630 

583 


APPENDIX  G 

Table  Country  Period  Title  Page 

60  Norway 1896-1912 Females 630 

61  "       1896-1910 By  Organs  and  Parts, 

according  to  Sex 631 

62  "       1896-1910 Relative  Mortality,  by 

Organs  and  Parts,  ac- 
cording to  Sex 631 

63  "       1896-1910 By  Age  and  Sex 631 

64  "       1896-1910 By  Organs  and  Parts, 

according     to     Age, 
Males 632 

65  "       1896-1910 By  Organs  and  Parts, 

according  to  Age,  Fe- 
males      632 

66  "       1896-1901 Urban  and  Rural,  by 

Organs  and  Parts,  ac- 
cording to  Sex 633 

67  "       1896-1907 By  Organs  and  Parts, 

and  Geographical  Di- 
visions    633 

68  Kristiania 1896-1912 Persons 633 

69  Bergen 1896-1912. ..........   Persons 634 

70  Hammerfest 1896-1911 Persons 634 

71  Sweden 1901-1912 By  Cities 634 

72  "       1911 Urban  and  Rural,  by 

Sex 634 

73  "       1905 By  Provinces  and  Sex    635 

74  "       1905 Urban  and  Rural,  by 

Organs     and     Parts, 
Males 636 

75  "       1905 Urban  and  Rural,  by 

Organs     and     Parts, 

Females 636 

76  Stockholm 1908-1913 Persons 637 

77  Goteborg 1908-1913 Persons 637 

78  Denmark 1881-1912 By  Cities 637 

79  "        1894-1912 By  Cities,  Males ... .     638 

80  "        1894-1912 By  Cities,  Females. . .     638 

81  "        1908-1912 Cities,  by  Organs  and 

Parts,  according  to  Sex    638 

82  Copenhagen 1894-1912 Persons 639 

83  "  1894-1912 By  Sex 639 

84  Iceland 1908 By  Organs  and  Parts, 

according  to  Sex 640 

85  Finland 1909 By  Organs  and  Parts, 

according  to  Sex 640 

86  "       1890-1907 By  Organs  and  Parts  641 

87  "       and  Sweden 1890-1907 By  Organs  and  Parts  641 

87a        "       1910 By  Cities 641 

88  German  Empire 1891-1912 Persons 642 

89  "  "      1905-1912 BySex 642 

90  Bavaria 1886-1912 Persons 643 

91  "       1886-1912 Males 643 

92  "       1886-1912 Females 644 

584 


APPENDIX  G 

Table                               Country                                    Period                                                      Title  Page 
German  Empire  {contiiiucJ) 

93  Bavaria 1905-1907 By  Geographical  Di- 

visions, Males 644 

94  "       1905-1907 By  Geographical  Di- 

visions, Females 645 

95  "       1905-1910 By  Organs  and  Parts, 

according  to  Sex 645 

95a                "       1901-1912 By  Age 646 

96  Prussia 1881-1912 Persons 646 

97  "       1898-1912 Males 647 

98  "      1898-1912 Females 647 

98a                "       1903-1913 By  Age  and  Sex 647 

99  Wiirttemberg 1904-1912 By  Sex 648 

100  Baden 1881-1912 Persons 648 

101  "      1905-1912 By  Sex 649 

102  Saxony 1904-1912 By  Sex 649 

103  Alsace-Lorraine 1905-1912 Persons 650 

103a           Grand-Duchy  of  Hesse.  . .  .1901-1912 By  Religion,  accord- 
ing to  Age  and  Sex .  .  650 

104  Hehgoland 1840-1903 Persons 650 

105  "  1840-1903 By  Organs  and  Parts, 

according  to  Sex 651 

106  Hamburg 1900-1912 By  Sex 651 

107  Bremen 1896-1913 Persons 652 

108  "       1896-1911 BySex 652 

109  Berlin 1881-1912 Persons 653 

110  "      1881-1912 Males 653 

111  "      1881-1912 Females 654 

112  Frankfurt   a/M 1891-1913 Persons 654 

113  "              1892-1913 Males 655 

114  "              1892-1913 Females 655 

115  "  1906-1912 By  Organs  and  Parts, 

according  to  Sex 656 

116  Cologne 1891-1912 Persons 656 

117  Essen   a/R 1906-1912 By  Sex 657 

118  Munich 1896-1912 Persons 657 

119  "       1896-1911 By  Sex 658 

120  "       1907-1909 By  Religious  Confes- 

sion,     according      to 
Organs      and     Parts, 

Females 658 

121  Dresden 1886-1912 Persons 659 

122  Leipzig 1881-1912 Persons 659 

123  Konigsberg 1881-1912 Persons 660 

124  Nuremberg 1881-1912 Persons 660 

125  Holland 1881-1913 Persons 661 

126  "       1901-1913 BySex 661 

127  "       1906-1912 By  Organs  and  Parts, 

according  to  Sex 662 

128  Amsterdam 1881-1913 Persons 662 

129  "          1901-1912 BySex 663 

585 


APPENDIX  G 

Table                               Country                                    Period                                                       Title  Page 
Holland  (continued) 

130  Amsterdam 1862-1902 By  Organs  and  Parts, 

Males 663 

131  "  1862-1902 By  Organs  and  Parts, 

Females 664 

132  "  1897-1902 By  Organs  and  Parts, 

according      to      Age, 

Males 664 

133  "  1897-1902 By  Organs  and  Parts, 

according  to  Age,  Fe- 
males    665 

134  The  Hague 1901-1913 Persons 665 

135  "         1901-1912 By  Sex 666 

136  Rotterdam 1901-1913 Persons 666 

137  "          1901-1912 By  Sex 667 

138  Belgium 1903-1912 Persons 667 

139  "        1903-1912 Males 667 

140  "       1903-1912 Females 668 

141  Liege 1903-1912 Persons 668 

142  "     1905-1912 BySex 668 

143  Antwerp 1896-1912 Persons 669 

144  Brussels 1901-1912 Persons 669 

145  France 1892-1911 Persons 670 

146  "      1906-1910 By   Cities,  according 

to  Size 670 

147  Paris 1881-1913 Persons 671 

148  "     1893-1913 Males 671 

149  "     1893-1913 Females 672 

150  Lyons 1910-1912 Persons 672 

151  Bordeaux 1909-1912 Persons 672 

152  Nice 1909-1912 Persons 672 

153  Lille 1891-1912 Persons 673 

154  Nancy 1901-1912 Persons 673 

155  Le  Havre 1901-1912 Persons 673 

156  Switzerland 1881-1912 Persons 674 

157  "           1881-1885— 1901-1912  Males 674 

158  "          1881-1885— 1901-1912  Females 675 

159  "  1901-1910 By  Organs  and  Parts, 

according  to  Sex ....  675 

160  "  1901-1910 Relative      Mortality, 

by  Organs  and  Parts, 

according  to  Sex 676 

161  "  ,1906-1910 By  Organs  and  Parts, 

according  to  Sex 676 

162  "  1906-1910 By       Cantons      and 

Race 677 

163  "          1901-1910 ByAgeandSex 677 

164  Bern 1901-1912 Persons 678 

165  Basel 1901-1912 Persons 678 

166  Geneva 1901-1912 Persons 678 

167  Zurich 1901-1912 Persons 678 

586 


APPENDIX  G 

Table  Country  Period  Title  Page 

168  Austria 1895-1912 Persons 679 

169  "       1901-1912 BySex 679 

170  "       1907-1911 By      Provinces      and 

Race 680 

171  "       1909-1910 By  Principal  Cities...  681 

172  Vienna 1900-1912 Persons 681 

173  "      1900-1912 By  Sex 682 

174  "      1898-1912 Jewish  Population ..  .  682 

175  "      1898-1912 Jewish  Population,  by 

Sex 683 

176  Hungary 1897-1912 Persons 683 

177  "        1897-1908 By  Sex 684 

178  "        1901-1904 By  Organs  and  Parts, 

according  to  Sex 685 

179  "       1904 Percentage  of  Distri- 

bution, by  Organs  and 

Parts,  according  to  Sex  685 

180  " 1901-1904 By  Race 686 

181  Budapest 1881-1912 Persons 686 

182  "        1881-1912 Males 687 

183  "        1881-1912 Females 687 

184  "        1902-1906 By  Religious  Confes- 

sion   688 

185  Italy 1887-1912 Persons 688 

186  "     1896-1912 Males 689 

187  "     1896-1912 Females 689 

'88        "     1906-1910 By  Provinces 690 

189  "     1891-1910 By  Organs  and  Parts.  690 

190  Rome 1898-1912 Persons 691 

191  Naples 1898-1912 Persons 691 

192  Genoa 1898-1912 Persons 691 

193  Turin 1898-1912 Persons 692 

194  Milan 1898-1912 Persons 692 

195  Florence 1898-1912 Persons 692 

196  Palermo 1898-1912 Persons 693 

197  Spain 1900-1912 Persons 693 

198  "     1900 Urban  and  Rural,  by 

Organs  and  Parts ....  693 

198a       "      1901-1905 By  Organs  and  Parts, 

according  to  Sex ....  694 

199  Madrid 1901-1910 Persons 694 

200  Portugal 1902-1910 Persons 694 

201  "        1902-1910 By  Sex 695 

202  "        1906-1910 By  Provinces 695 

203  "        1904 By  Organs  and  Parts, 

according  to  Sex  (Can- 
cer Census) 696 

204  Porto 1893-1910 Persons 696 

205  Lisbon 1902-1910 Persons 697 

587 


APPENDIX  G 

Table  Country  Period  Title  Page 

Russia 

206  Moscow 1892-1910 By  Sex 697 

207  "       1910-1912 Persons 697 

208  Petrograd 1911-1912 Persons 697 

208a  Warsaw 1881-1912 Persons 698 

209  Serbia 1892-1912 Persons 698 

210  "      1907-1912 Cities 699 

211  Greece 1900-1908 , . . .  Twelve  Cities 699 

212.  "  1905-1908 Twelve  Cities,  by  Or- 
gans and  Parts,  ac- 
cording to  Sex 699 

213  Athens 1900-1908 By  Sex 700 

214  Roumania 1901-1912 By  Cities 701 

Turkey 

215  Constantinople 1908-1912 Persons 701 

216  "  1908-1912 By  Religion 701 

217  Africa By  Countries 702 

218  Algeria 1904-1912 European  Population      702 

219  Mauritius 1898-1912 Persons 703 

220  "         1898-1908 Public  Hospital  Cases    703 

221  Union  of  South  Africa 1912 By  Organs  and  Parts, 

according  to  Sex, 
White 703 

222  "  "  "     1912 By   Provinces,  White    704 

223  Cape  Colony 1900-1908 Tw«nty-five  Cities  and 

Towns 704 

224  Johannesburg 1909-1911 By  Race 704 

225  Natal 1902-1912 European  Population.     705 

226  "     1903-1912 East  Indians 705 

227  Sierra  Leone 1870-1909 Cases  in  the  Colonial 

Hospital 705 

228  "  "      1900-1909 Cases  in  the  Colonial 

Hospital,    by   Organs 

and  Parts 706 

229  Freetown 1910-1911 Persons 706 

Portuguese  Colonies 

230  Cape  Verde  Islands 1892-1904 Cases  of  Tumor,  Hos- 

pital da  Praia,  by  Race     706 

231  "         "  "       1892-1904 Cases  of  Cancer,  Hos- 

pital da  Praia,  by  Or- 
gans and  Parts,  accord- 
ing to  Race  and  Sex. . .     707 

232  Asia By  Countries 708 

India 

233  Calcutta 1881-1913 Persons 708 

234  Province  of  Bengal 1911-1912 Morbidity   and   Mor- 

tality in  Hospitals .  .  .     709 

235  Ceylon 1881-1913 Persons 709 

236  "       1911-1913 By  Organs  and  Parts    710 

237  "       1911-1913 By  Organs  and  Parts, 

according  to  Race.  . .     710 

238  "       1911-1913 By  Administrative  Di- 

visions       711 

588 


APPENDIX  G 

Table                               Country                                    Period                                                       Title  Page 

239  Straits  Settlements 1904-1912 Cases  of  Cancer  in  the 

Hospitals 711 

240  Singapore 1904-1913 Persons 712 

241  Province  of  Penang 1909-1913 Persons 712 

242  Singapore 1907-1912 Cases    in   Tan    Toch 

Seng's    Hospital,    by 

Organs  and  Parts. . . .  712 

243  Seychelles. 1900-1902—1907-1911  Victoria  Hospital  Ex- 

perience    713 

244  "        1907-1911 Victoria  Hospital  Ex- 

perience,   by    Organs 

and  Parts 713 

245  Dutch  East  Indies 1911-1912 Europeans 713 

China 

246  Hongkong 1901-1912 By  Race 714 

247  "         1895-1904 By  Organs  and  Parts, 

Chinese  Population  . .  714 

248  Shanghai 1898-1914 Resident  Foreign  Pop- 

ulation   715 

248a  Fukien 1911-1914 Yunghun  Hospital  Ex- 

perience,   by   Organs 

and  Parts 715 

249  Japan 1899-1911 Persons 715 

250  "     1899-1910 By  Sex 716 

251  "     1909-1910 By  Organs  and  Parts, 

according  to  Sex 716 

252  "     1908-1910 By  Age  and  Sex 717 

253  Tokyo 1904-1910 Persons 717 

254  "     1904-1910 By  Sex 718 

255  Osaka 1906-1910 By  Sex 718 

256  Kyoto 1906-1910 By  Sex 719 

Philippine  Islands 

257  Manila 1903-1913 Persons 719 

258  "      1908-1913 By  Organs  and  Parts, 

according  to  Race .  .  .  719 

259  Australasia By  Countries 720 

260  Commonwealth  of  AustraHa 1881-1913 Persons 720 

261  "  "  ....  1908-1912 By  Organs  and  Parts, 

according  to  Sex 721 

262  "                        "          ....1908-1912.. By  Age  and  Sex 722 

263  New  South  Wales 1881-1913 Persons 723 

264  "         "          "      1881-1913 Males 724 

265  "         "          "      1881-1913 Females 724 

266  "         "          "      1881-1911 By  Age  and  Sex 725 

267  Sydney 1891-1913 Persons 726 

268  "      1891-1913 Males 726 

269  "      1891-1913 Females 727 

270  Victoria 1881-1913 Persons 727 

271  "       1881-1913 Males 728 

272  "       1881-1913 Females 728 

273  " 1880-82, 1890-92, 1900-02, 1909-11  By  Age  and  Sex 729 

589 


APPENDIX  G 

Table                               Country                                    Period  Title  Page 
Commonwealth  of  Australia  {continued) 

274  South  Austraha 1881-1913 Persons 730 

275  "  "        1882-1913 Males 730 

276  "  "        1882-1913 Females 731 

277  Queensland 1881-1913 Persons 731 

278  "  1893-1913 Males 732 

279  "  1893-1913 Females 732 

280  Tasmania 1884-1913 Persons 733 

281  "         1892-1913 Males 733 

282  "         1892-1913 Females 734 

283  Western  Australia 1881-1913 Persons 734 

284  "  "        1897-1913 Males 735 

285  "  "        1897-1913 Females 735 

286  Northern  Territory 1911-1913 Persons 735 

287  New  Zealand 1881-1913 Persons 736 

288  "  "       1889-1913 Males 736 

289  "  "       1889-1913 Females 737 

290  Fiji 1898-1911 Colonial  Hospital  Ex- 

perience   737 

291  " 1905-1911 Colonial  Hospital  Ex- 

perience,   by    Organs 

and  Parts 738 

292  "   1906-1911 Colonial  Hospital  Ex- 

perience, by  Race. . .  738 

293  Hawaii 1902-1913 Persons 739 

294  "      1911-1913 By  Race 739 

295  "      1911-1913 By  Organs  and  Parts, 

according  to  Race.  .  .  739 

296  America By  Countries 740 

Canada 

297  Pro\nnce  of  Ontario 1881-1913 Persons 741 

298  Toronto 1881-1913 Persons 741 

299  "       1881-1913 Males 742 

300  "       1881-1913 Females 742 

301  Montreal 1881-1913 Persons 743 

302  City  of  Quebec 1894-1912 Persons 744 

303  Winnipeg 1910-1913 By  Sex 744 

304  British  Columbia 1901-1913 Persons 745 

305  Nova  Scotia 1910-1913 By  Sex 745 

306  Prince  Edward  Island 1913-1914 Persons 745 

New  Brunswick 

307  St.  John 1891-1913 Persons 746 

308  Newfoundland  and  Labrador.  .  .  1906-1913 Persons 746 

309  Bermuda  Islands 1891-1913 Persons 747 

310  "  "      1891-1913 Males 747 

311  "  "      1891-1913 Females 748 

312  Jamaica 1881-1913 Persons 748 

313  "       1881-1913 Males 749 

314  "       1881-1913 Females 749 

315  Windward  and  Leeward  Islands .  1901-1912 Persons 750 

590 


APPENDIX  G 

Table                               Country                                      Period                                                        Title  Page 

316  Trinidad 1890-1913 Persons 750 

317  Barbados 1899-1903 Hospital  Experience. .  751 

Danish  West  Indies 

318  St.  Thomas 1901-1914 Persons 751 

319  British  Honduras ." . .  .  1894-1913 Persons 751 

320  British  Guiana 1896-1913 Persons 752 

321  "             "      1896-1913 Males 752 

322  "            "      1896-1913 Females 753 

Dutch  Guiana 

323  Paramaribo 1903-1912 Persons 753 

324  "          1903-1912 By  Sex 754 

325  Cuba 1901-1913 Persons 754 

326  "     1902-1913 By  Sex 755 

327  "     1908-1912 By  Organs  and  Parts, 

according  to  Sex 755 

328  "     1908-1912 By  Organs  and  Parts, 

according  to  Race .  .  .  756 

329  Havana 1899-1912 Persons 756 

330  Porto  Rico 1910-1913 Persons 757 

331  "         "    1910-1913 By  Organs  and  Parts  757 

Mexico 

332  City  of  Mexico 1905-1913 By  Sex 758 

333  "  "      1908-1912 By  Organs  and  Parts, 

according  to  Sex 759 

334  Costa  Rica 1901-1912 Persons 759 

335  Nicaragua 1908-1911 Persons 759 

Salvador 

336  San  Salvador 1912 By  Organs  and  Parts  760 

337  Venezuela 1905-1912 Persons 760 

Colombia 

338  Bogota 1912-1913 Persons 760 

Ecuador 

339  Guayaquil 1910-1912 Persons 760 

Bolivia 

340  La  Paz 1900-1909 Persons 760 

Peru 

341  Lima 1904 By  Organs  and  Parts, 

according  to  Sex 761 

342  Trujillo 1903-1913 Persons 761 

Brazil 

343  City  of  Rio  de  Janeiro 1891-1913 Persons 762 

344  Fed.  Dist.  of  Rio  de  Janeiro  1903-1913 Persons 762 

345  "  "  "       1906-1910 By  Organs  and  Parts, 

Males 763 

346  "  "  "       1906-1910 By  Organs  and  Parts, 

Females 763 

347  City  of  Bahia 1897-1912 Persons 764 

348  "             "       1900-1911 Males 764 

349  "            "       1900-1911 Females 765 

350  "  "      1904-1908 By  Organs  and  Parts, 

according  to  Sex 765 

591 


APPENDIX  G 

Table  Country    '  Period  Title  Page 

Brazil  {continued) 

351  City  of  Sao  Paulo 1896-1913 Persons 766 

352  "         "        "     1901-1913 Males 766 

353  "         "        "     1901-1913 Females 766 

354  State  of  Parana 1906-1910 • Persons 767 

355  Pelotas 1906-1913 Persons 767 

356  Bello  Horizonte 1910-1912 Persons 767 

Argentine  Republic 

357  Province  of  Buenos  Aires. .  .  1895-1912 Persons 767 

358  "  "  "     ...1895-1912 Males 768 

359  "  "  "     . .  .1895-1912 Females 768 

360  City  of  Buenos  Aires 1882-1913 Persons 769 

361  "  "  "     1896-1913 Males 769 

362  "  "  "     1896-1913 Females 770 

363  "  "  "     1907-1911 By  Organs  and  Parts, 

according  to  Sex 770 

364  Rosario  de  Santa  Fe 1904-1913 Persons 771 

365  "  "        1904-1911 Males 771 

366  "  "        1904-1911 Females 771 

367  Province  of  Tucuman 1901-1912 Persons 771 

368  Santiago  del  Estero 1891-1913 Persons 772 

369  Chile 1892-1912 Persons 772 

370  Prov.  of  Santiago  de  Chile .  .  1904-1912 Persons 773 

371  City  of  Santiago  de  Chile  . .  1898-1909 Persons 773 

372  "  "  "      . .  1898-1902 By  Organs  and  Parts  773 

373  Uruguay 1891-1913 Persons 774 

374  "        1905-1912 Males 774 

375  "        1905-1912 Females 774 

376  "        1906-1910 By  Organs  and  Parts, 

according  to  Sex ....  775 

377  Montevideo 1903-1913 Persons 775 

378  "  1907-1911 By  Organs  and  Parts  775 


592 


APPENDIX  G 


Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

3,018 

33.4 

148,447 

54.4 

251,438 

65.7 

20,345 

73.0 

1,096,716 

76.6 

1,519,964 

71.6 

Table  1 
Mortality  from  Cancer  in  the  Civilized  World,  1908-1912 

Population 

Africa 9,041,866 

Asia 272,814,962 

America 382,549,311 

Australasia 27,886,740 

Europe 1,431,996,861 

Total 2,124,289,740 

Population,  1911:  439,699,139. 

Table  2 
Mortality  from  Cancer,  by  Countries,  1901-1905  Compared  with  1906-1910 

Rate  per  100, 
1901-1905 

Cuba 33.7 

Uruguay 53.9 

Scotland 84.8 

Ontario 51.3 

Brazil* 33.4 

Italy 55.2 

Ireland 68.5 

Japan 54.0 

Australian  Commonwealth 62.5 

Spain 44.4 

Hungary 39.1 

France* 92.1 

British  Columbia 30.3 

German  Empire 77.7 

England  and  Wales 86.7 

Jamaica 16.8 

New  Zealand 67.4 

United  States 67.9 

Denmark* 129.1 

Holland 97.8 

Austria 74.7 

Sweden* 102.2 

Norway 94.9 

Argentine  Republicf 70.1 

Switzeriand 128.3 

Total 67.7 

*Cities  only.      fProvince  and  city  of  Buenos  Aires  only. 

Table  3 
Crude  and  Standardized  Cancer  Mortality  Rates  per  100,000  of  Population 
Selected  Countries,  1908-1912 


000  Population 

Percentage  of 

1906-1910 

Increase 

43.3 

28.5 

66.5 

23.4 

99.7 

17.6 

60.1 

17.2 

39.0 

16.8 

63.6 

15.2 

78.8 

15.0 

62.0 

14.8 

70.3 

12.5 

49.8 

12.2 

43.6 

11.5 

102.7 

11.5 

33.4 

10.2 

84.2 

8.5 

94.0 

8.4 

18.1 

7.7 

72.1 

7.0 

72.6 

6.9 

137.3 

6.4 

103.5 

5.8 

78.3 

4.8 

104.5 

2.2 

96.6 

1.8 

71.3 

1.7 

125.9 

-1.1 

74.3 

9.7 

Crude  Standardized 

Rate  Rate* 

Switzeriand 127.1  107.8 

Bavaria 113.8  104.9 

Holland 106.4  92.6 

England  and  Wales.     97.6  89.5 

Norway 97.4  75.5 

Ireland 81.2  61.9 


Crude  Standardized 

Rate  Rate* 

U.  S.  Reg.  Area 74.7  73.9 

Australia 74.3  76.2 

Uruguay Q5.5  98.8 

Italy 65.2  63.5 

Japan 64.3  58.5 

Cuba 44.4  60.3 


*Standardized  on  the  basis  of  the  standard  million  of  England  and  Wales,  1901. 


593 


APPENDIX  G 

Table  4 
Mortality  from  Cancer  in  Countries  of  Europe 


Deaths  Rate  per 

Population  from  100,000 

Cancer  Population 

Austria 141,462,903  113,221  80.0 

Belgium 36,936,410  24,712  66.9 

Channel  Islands 208,900  227  108.7 

Denmark 5,453,322  7,747  142.1 

England  and  Wales 178,980,717  174,602  97.6 

France 196,878,000  148,662  75.5 

German  Empire 318,876,524  277,710  87.1 

Gibraltar 97,823  81  82.8 

Greece 2,117,670  1,100  51.9 

Holland 29,479,395  31,375  106.4 

Hungary 104,006,496  47,347  45.5 

Ireland 21,925,004  17,796  81.2 

Isleof  Man 261,530  339  129.6 

Italy 171,995,665  112,087  65.2 

Malta 1,056,196  512  48.5 

Norway 11,774,100  11,461  97.4 

Portugal 29,060,580  6,504  22.4 

Roumania 6,410,450  3,940  61.5 

Russia 8,624,796  7,812  90.6 

Scotland 23,686,521  24,399  103.0 

Serbia 13,876,836  1,669  12.0 

Spain 97,705,000  51,135  52.3 

Sweden 6,685,581  7,022  105.0 

Switzerland 18,686,442  23,228  124.3 

Turkey. , 5,750,000  2,001  34.8 

Total 1,431,996,861  1,096,716  76.6 

Population,  1911:  291,384,190. 

NOTES  TO  TABLE  4 

Austria 1908-1912 

Belgium 1908-1912 

Channel  Islands Guernsey,  1909-1913 

Denmark All  cities,  1908-1912 

England  and  Wales 1908-1912 

France 1906-1910 

German  Empire 1908-1912 

Gibraltar 1908-1912 

Greece 12  cities,  1904-1908 

Holland 1908-1912 

Hungary 1908-1912 

Ireland 1908-1912 

Isleof  Man 1908-1912 

Italy 1908-1912 

Malta 1908-1912 

Norway 1908-1912 

Portugal 1906-1910 

Roumania All  cities,  1907-1911 

Russia Moscow,  1910-1912,  Petrograd,  with  suburbs,  1911-1912 

Scotland 1908-1912 

Serbia 1905-1909 

Spain 1908-1912 

Sweden. All  cities,  1907-1911 

Swdtzerland 1908-1912 

Turkey Constantinople,  1908-1912 

594 


APPENDIX  G 

Table  5 
Mortality  from  Cancer  in  Countries  of  Europe 
1896-1910 


1896-1900 

Deaths  Rate  per 

Population  from  100,000 
Cancer     Population 

England  and  Wales     157,609,380  126,206       80.1 

Scotland 21,725,362  16,753       77.1 

Ireland 22,561,358  13,100       58.1 

Norway 10,769,800  9,234       85.7 

Denmark* '       4,477,360  5,325  118.9 

German  Empire.  ..    254,148,664  179,863      70.8 

Holland 25,166,349  23,134       91.9 

Switzerland 16,127,599  20,544  127.4 

Austria 127,026,960  87,570      68.9 

Hungary 75,364,810t  23,134t     30.7 

Italy 159,631,670  81,332       50.9 

France* 65,951,116  64,185       97.3 

Total 940,560,428  650,380       69.1 


1901-1905 

Deaths 

Population 

from 

Cancer 

166,489,397 

144,351 

22,676,880 

19,223 

22,106,804 

15,148 

11,314,400 

10,732 

4,923,381 

6,357 

280,410,950 

217,866 

26,840,255 

26,239 

17,142,770 

21,995 

133,280,624 

99,542 

98,225,662 

38,366 

164,281,879 

90,757 

70,461,200 

64,865 

Rate  per 

100,000 

Population 

86.7 
84.8 
68.5 
94.9 

129.1 
77.7 
97.8 

128.3 
74.7 
39.1 
55.2 
92.1 


1,018,154,202   755,441    74.2 


1900-1910 

Deaths  Rate  per 

Population                from  100,000 

Cancer  Population 

England  and  Wales.    175,333,013       164,790  94.0 

Scotland 23,394,061         23,316  99.7 

Ireland 21,942,708         17,299  78.8 

Norway 11,606,600         11,213  96.6 

Denmark* 5,288,066          7,259  137.3 

German  Empire ..  .    310,481,457       261,311  84.2 

Holland 28,725,355         29,727  103.5 

Switzerland 18,237,395         22,963  125.9 

Austria 139,193,082       108,947  78.3 

Hungary 102,167,372        44,550  43.6 

Italy 169,120,165       107,575  63.6 

France* 71,714,000        73,643  102.7 

Total 1,077,203,274       872,593        81.0 

Note:  From  1896-1900  to  1901-1905  the  cancer  mortality  increased  5.05  per  100,000 
of  population,  or  7.3  per  cent.  From  1901-1905  to  1906-1910  it  increased  6.81  per  100,000 
of  population,  or  9.2  per  cent. 

♦Cities  only.      fFour  years  only  (1897-1900). 


595 


APPENDIX  G 


Table  6 

Table  7 

Mortality  from  Cancer  in  England 

Mortality  from  Cancer  in  England 

and  Wales 

and  Wales, 

Males 

1881-19 

13 

Deaths 

Rate  per 

1881-19 

13 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer   Population 

Cancer  Population 

1881 

26.046,142 

13,542 

52.0 

1881 

12,673,435 

4,611 

36.4 

1882 

26,334,942 

14,057 

53.4 

1882 

12,808,460 

4,685 

36.6 

1883 

26,626,949 

14,614 

54.9 

1883 

12,944,923 

4,967 

38.4 

1884 

26,922,192 

15,198 

56.5 

1884 

13,082,837 

5,346 

40.9 

1885 

27,220,706 

15,560 

57.2 
54.8 

1885 
1881-1885 

13,222,216 

5,495 

41.6 

1881-1885 

133,150,931 

72,971 

64,731,871 

25,104 

38.8 

1886 

27,522,532 

16,243 

59.0 

1886 

13,363,079 

5,754 

43.1 

1887 

27,827,706 

17,113 

61.5 

1887 

13,505,441 

6,262 

46.4 

1888 

28,136,258 

17,506 

62.2 

1888 

13,649,314 

6,284 

46.0 

1889 

28,448,239 

18,654 

65.6 

1889 

13,794,721 

6.891 

50.0 

1890 

28,763,673 

19,433 

67.6 
63.2 

1890 
1886-1890 

13,941,671 

7,137 

51.2 

1886-1890 

140,698,408 

88,949 

68,254,226 

32,328 

47.4 

1891 

29,085,819 

20,117 

69.2 

1891 

14,092,535 

7,294 

51.8 

1892 

29,421,392 

20,353 

69.2 

1892 

14,252,190 

7,547 

53.0 

1893 

29,760,842 

21,135 

71.0 

1893 

14,413,657 

7,908 

54.9 

1894 

30,104,201 

21,422 

71.2 

1894 

14,576,948 

8,077 

55.4 

1895 

30,451,528 

22,945 

75.3 
71.2 

1895 
1891-1895 

14,742,091 

8,628 

58.5 

1891-1895 

148,823,782 

105,972 

72,077,421 

39,454 

54.7 

1896 

30,802,858 

23,521 

76.4 

1896 

14,909,104 

9,216 

61.8 

1897 

31,158,245 

24,443 

78.4 

1897 

15,078,010 

9,573 

63.5 

1898 

31,517,725 

25,196 

79.9 

1898 

15,248,823 

9,932 

65.1 

1899 

31,881,365 

26,325 

82.6 

1899 

15,421,578 

10,337 

67.0 

1900 

32,249,187 

26,721 

82.9 
80.1 

1900 
1896-1900 

15,596,283 

10,475 

67.2 

1896-1900 

157,609,380 

126,206 

76,253,798 

49,533 

65.0 

1901 

32,612,134 

27,487 

84.3 

1901 

15,769,478 

10,891 

69.1 

1902 

32,951,455 

27,872 

84.6 

1902 

15,933,989 

11,098 

69.6 

1903 

33,294,308 

29,089 

87.4 

1903 

16,100,211 

11,799 

73.3 

1904 

33,640,736 

29,682 

88.2 

1904 

16,268,166 

12,086 

74.3 

1905 

33,990,764 

30,221 
144,351 

88.9 
86.7 

1905 
1901-1905 

16,437,866 

12,470 

75.9 

1901-1905 

166,489,397 

80,509,710 

58,344 

72.5 

1906 

34,344,429 

31,668 

92.2 

1906 

16,609,330 

13,257 

79.8 

1907 

34,701,776 

31,745 

91.5 

1907 

16,782,579 

13,199 

78.6 

1908 

35,062,847 

32,717 

93.3 

1908 

16,957,634 

13,901 

82.0 

1909 

35,427,072 

34,053 

96.1 

1909 

17,134,508 

14,263 

83.2 

1910 

35,796,289 

34,607 

96.7 
94.0 

1910 
1906-1910 

17,313,221 

14,843 

85.7 

1906-1910 

175,333,013 

164,790 

84,797,272 

69,463 

81.9 

1911 

36,162,046 

35,902 

99.3 

1911 

17,490,286 

15,589 

89.1 

1912 

36,531,203 

37,323 

102.2 

1912 

17,668,999 

16,188 

91.6 

1913 

36,919,339 

38,939 

105.5 

1913 

17,857,014 

16,918 

94.7 

Source : 

Annual  Reports  of  th 

e  Regis- 

Source: 

Annual  Reports  of  th 

e  Regis- 

trar-General  of  Births, 

Deaths  and  Mar- 

trar-General  of  Births, 

Deaths  and  ]\lar- 

riages  in  England  and  Wales. 

riages  in  England  and  Wales. 

596 


APPENDIX  G 


Table  f 

Mortality  from  Cane 

and  Wales,  F 

1881-191 

5 

:er  in  Er 

emales 

3 

Deaths 
from 

Cancer  '. 

8,931 
9,372 
9,647 
9,852 
10,065 

Igland 

Rate  per 

100,000 

■Population 

66.8 
69.3 
70.5 
71.2 
71.9 

70.0 

74.1 
75.8 
77.5 
80.3 
83.0 

78.2 

85.5 
84.4 
86.2 
85.9 
91.1 

86.7 

90.0 
92.5 
93.8 
97.1 
97.6 

94.2 

98.5 

98.6 

100.6 

101.3 

101.1 

.100.0 

103.8 
103.5 
103.9 
108.2 
106.9 

105.3 

108.8 
112.0 
115.5 

e  Regis- 
id  Mar- 

Mortali 
an 

Ages 

Under  35 

35-44 

45-54 

55-64 

65-74 

75-84 

85  and  ov€ 

All  ages 

Under  35 

35-44 

45-54 

55-64 

65-74 

75-84 

85  and  ove 

All  ages 

Under  35 

35-44 

45-54 

55-64 

65-74 

75-84 

85  and  ovc 

All  ages 

Source: 
trar-Genei 
riages  in  I 

Table 
ty  from  Can( 
d  Wales,  ace 
Age  and 
1901-191 

9 

;er  in  Er 

ording  t 

Sex 

10 

Deaths 
from 
Cancer 

12,595 
27,992 
62,287 
87,997 
80,605 
33,557 
4,108 

Igland 
o 

Population 

13,372,707 
13,526,482 
13,682,026 
13,839,355 
13,998,490 

Year 

1881 
1882 
1883 
1884 
1885 

TOTAL 

Population 

227,920,310 
43,957,297 
31,966,672 
21,101,120 
12,099,817 
4,217,306 
>r        559,888 

Rate  per 
100,000 
'opulation 

5.5 

63.7 

194.8 

1881-1885 

1886 
1887 

68,419,060 

14,159,453 
14,322,265 
14,486,944 
14,653,518 
14,822,002 

47,867 

10,489 
10,851 
11,222 
11,763 
12,296 

417.0 
666.2 
795.7 
733.7 

1888 
1889 
1890 

341,822,410 

MALES 

111,499,560 

21,222,110 

15,363,631 

9,911,807 

5,367,518 

1,739,029 

r        203,327 

309,141 

5,465 

8,773 
23,779 
38,675 
35,831 
13,810 

1,474 

90.4 

1886-1890 

1891 
1892 
1893 
1894 
1895 

72,444,182 

14,993,284 
15,169,202 
15,347,185 
15,527,253 
15,709,437 

56,621 

12,823 
12,806 
13,227 
13,345 
14,317 

4.9 
41.3 
154.8 
390.2 
667.6 
794.1 
724.9 

1891-1895 

1896 
1897 
1898 
1899 
1900 

76,746,361 

15,893,754 
16,080,235 
16,268,902 
16,459,787 
16,652,904 

66,518 

14,305 
14,870 
15,264 
15,988 
16,246 

165,306,982     127,807 
FEMALES 

116,420,750        7,130 

22,735,187       19,219 

16,603,041       38,508 

11,189,313       49,322 

6,732,299       44,774 

2,478,277       19,747 

;r        356,561         2,634 

77.3 

6.1 

84.5 

231.9 

440.8 

1896-1900 
1901 

81,355,582 

16,842,656 
17,017,466 
17,194,097 
17,372,570 
17,552,898 

76,673 

16,596 
16,774 
17,290 
17,596 
17,751 

665.1 
796.8 

738.7 

1902 
1903 
1904 
1905 

176,515,428     181,334 

Annual  Reports  of  th 
al  of  Births,  Deaths  a 
England  and  Wales. 

102.7 

e  Regis- 
ad  Mar- 

1901-1905 

1906 
1907 
1908 
1909 
1910 

85,979,687 

17,735,099 
17,919,197 
18,105,213 
18,293,164 
18,483,068 

86,007 

18,411 
18,546 
18,816 
19,790 
19,764 

1906-1910      90,535,741       95,327 

1911  18,672,360       20,313 

1912  18,862,264       21,135 

1913  19,062,325       22,021 

Source:     Annual  Reports  of  th 
trar-General  of  Births,  Deaths  ai 
riages  in  England  and  Wales. 

597 


APPENDIX  G 

Table  10 

Mortality  from  Cancer  in  England  and  Wales,  by  Organs  and  Parts 

according  to  Sex,  1908-1912 


Organ  or  Part 


Deaths 

from 
Cancer 


Lips 1,134 

Tongue 4,278 

Mouth 1,493 

Jaw 2,149 

Pharynx 1,438 

CEsophagus 5,298 

Stomach 15,780 

Liver  and  gall-bladder 8,406 

Peritoneum  and  mesentery 676 

Intestines 6,985 

Rectum 7,452 

Pancreas 1,486 

Ovaries  and  fallopian  tube 

Uterus 

Breast 118 

Skin 2,076 

Larynx 1,662 

Lungs  and  pleura 1,193 

Kidneys  and  suprarenal  glands .  .  .      774 

Bladder 2,245 

Prostate 1,665 

Brain 546 

Other  organs 6,696 

Not  specified 1,234 


All  organs 74,784 


MALES 


Rate  per 

100,000 

Population 

1.3 
4.9 
1.7 
2.5 
1.7 
6.1 
18.2 
9.7 
0.8 
8.1 
8.6 
1.7 


0.1 

2.4 
1.9 
1.4 
0.9 
2.6 
1.9 
0.6 
7.7 
1.4 

86.4 


Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

105 

0.1 

400 

0.4 

221 

0.2 

726 

0.8 

406 

0.4 

1,707 

1.8 

14,437 

15.6 

12,571 

13.6 

1,452 

1.6 

9,581 

10.4 

6,018 

6.5 

1,462 

1.6 

2,221 

2.4 

19,673 

21.3 

17,189 

18.6 

1,332 

1.4 

486 

0.5 

855 

0.9 

766 

0.8 

978 

1.1 

420 

0.5 

6,770 

6.2 

1,042 

1.1 

99,818 


108.0 


Males,  45  years  and  over,  20.57  per  cent,  of  population.     Females,  45  years  and  over, 
22.10  per  cent,  of  population. 

Source:    Annual  Reports  of  the  Registrar-General  of  Births,  Deaths  and  Marriages, 
in  England  and  Wales. 


598 


APPENDIX  G 

Table  11 

Mortality  from  Cancer  in  England  and  Wales,  by  Organs  and  Parts,  Males 

1897-1900  Compared  with  1901-1910 


Organ  or  Part 


1897 
Deaths 
from 
Cancer 

997 
647 

508 


Skin 

Lips 

Mouth 

Tongue 2,124 

Jaw 1,071 

Lymphatic  glands  of  neck 1,084 

Pharynx  and  throat 891 

Larynx 740 

Lungs 536 

(Esophagus 2,358 

Stomach 8,369 

Pancreas 550 

Liver  and  gall-bladder 5,532 

Rectum 3,672 

Other  intestines. .' 2,734 

Peritoneum 395 

Kidney 405 

Bladder  and  urethra 1,189 

Breast 79 

Male  generative  organs 1,015 

Other  organs 3,566 

Not  specified 1,855 


All  organs 


■1900 

Rate  per 

100,000 

Popuhilioii 

1.63 
1.05 
0.83 
3.46 
1.75 
1.77 
1.45 
1.21 
0.87 
3.84 
13.64 
0.90 
9.02 
5.99 
4.46 
0.64 
0.66 
1.94 
0.13 
1.65 
5.81 
3.02 


40,317         65.72 


1901- 

Deaths 

from 

Cancer 

2,945 

2,001 

2,241 

7,092 

3,697 

3,585 

2,967 

2,518 

1,688 

8,406 

27,324 

2,391 

15,823 

12,963 

10,583 

1,076 

1,381 

3,960 

236 

3,815 

9,930 

1,185 


1910 

Rate  per 

100,000 

Population 

1.78 
1.21 
1.36 
4.29 
2.24 
2.17 
1.79 
1.52 
1.02 
5.09 
16.53 
1.45 
9.57 
7.84 
6.40 
0.65 
0.84 
2.40 
0.14 
2.31 
5.99 
0.72 


127,807         77.31 


Percentage 

of 

Increase 

9.2 
15.2 
63.9 
24.0 
28.0 
22.6 
23.4 
25.6 
17.2 
32.6 
21.2 
61.1 

6.1 
30.9 
43.5 

1.6 
27.3 
23.7 

7.7 
40.0 

3.1 
—76.2 

17.6 


Source:     Annual  Reports  of  the  Registrar-General  of  Births,  Deaths  and  Marriages 
in  England  and  Wales. 


599 


APPENDIX  G 

Table  12 

Mortality  from  Cancer  in  England  and  Wales,  by  Organs  and  Parts,  Females 

1897-1900  Compared  with  1901-1910 


Organ  or  Part 


1897- 

Deaths 

from 
Cancer 

608 
74 
115 
271 
397 
405 
334 


Skin 

Lips 

Mouth 

Tongue 

Jaw 

Lymphatic  glands  of  neck 

Pharynx  and  throat 

Larynx 282 

Lungs 363 

Oesophagus 852 

Stomach 8,355 

Pancreas 529 

Liver  and  gall-bladder 8,654 

Rectum.... 3,240 

Other  intestines 3,597 

Peritoneum 1,050 

Kidney 446 

Bladder  and  urethra 539 

Breast 9,790 

Uterus 14,309 

Ovary 1,053 

Other  organs 4,248 

Not  specified 2,857 


All  organs 62,368 


1900 

Rate  per 

100,000 

Population 

0.93 
0.11 
0.18 
0.41 
0.61 
0.62 
0.51 
0.43 
0.55 
1.30 

12.76 
0.81 

13.22 
4.95 
5.50 
1.60 
0.68 
0.82 

14.96 

21.86 
1.61 
6.49 
4.36 

95.27 


1901-1910 


Deaths 

from 

Cancer 

2,053 

169 

370 

854 

1,335 

1,102 

831 

834 

1,317 

2,804 

25,814 

2,268 

24,021 

10,819 

14,342 

2,634 

1,411 

1,688 

30,493 

39,562 

3,617 

11,378 

1,628 


Rate  per 

100,000 

Population 

1.16 
0.10 
0.21 
0.48 
0.76 
0.62 
0.47 
0.47 
0.75 
1.59 

14.62 
1.28 

13.61 
6.13 
8.13 
1.49 
0.80 
0.96 

17.27 

22.41 
2.05 
6.45 
0.92 


181,334       102.73 


Percentage 

of 

Increase 

24.7 

-9.1 

16.7 

17.1 

24.6 

0.0 

-7.8   ■ 

9.3 

36.4 

22.3 

14.6 

58.0 

3.0 

23.8 

47.8 

-6.9 

17.6 

17.1 

15.4 

2.5 

27.3 

-0.6 

-78.9 

7.8 


Source:    Annual  Reports  of  the  Registrar-General  of  Births,  Deaths  and  Marriages 
in  England  and  Wales. 


600 


APPENDIX  G 

Table  13 

Mortality  from  Cancer  in  England  and  Wales 

Relative  Cancer  Mortality  of  Females,  by  Organs  and  Parts 

1901-1910 


Rate  per  100,000  Population 

Organ  or  Part  Males  Females 

Breast.. 0.14  17.27 

Generative  organs 2.31  24.46 

Peritoneum 0.65  1.49 

Liver  and  gall-bladder 9.57  13.61 

Other  intestines 6.40  8.13 

Kidney 0.84  0.80 

Stomach 16.53  14.62 

Pancreas 1.45  1.28 

Rectmn 7.84  6.13 

Lungs 1.02  0.75 

Skin 1.78  1.16 

Bladder  and  urethra 2.40  0.96 

Jaw 2.24  0.76 

(Esophagus 5.09  1.59 

Larynx 1.52  0.47 

Lymphatic  glands  of  neck 2.17  0.62 

Pharynx  and  throat 1.79  0.47 

Mouth 1.36  0.21 

Tongue 4.29  0.48 

Lips 1.21  0.10 

All  organs 77.31  102.73 


Relative  Mortality 
of  Females 

12,336 

1,059 

229 

142 

127 

95 


78 
74 
65 
40 
34 
31 
31 
29 
26 
15 
11 


133 


Note:     In  this  table  the  mortality  of  males  from  cancer  of  any  organ  or  part  is  taken 
as  100  and  the  corresponding  mortality  of  females  is  given  accordingly. 

Table  14 
Mortality  from  Cancer  of  the  Female  Breast  in  England  and  Wales 

1903-1912 

Deaths  from  Rate  per 

Female                        Cancer  of  100,000 

Year                                                                                             Population                   the  Breast  Population 

1903 17,194,097                   2,948  17.1 

1904 17,372,570                   2,997  17.3 

1905 17,552,898                   2,944  16.8 

1906 17,735,099                   2,997  16.9 

1907 17,919,197                   3,162  17.6 

1903-1907 87,773,861                  15,048  17.1 

1908 18,105,213                  3,221  17.8 

1909 18,293,164                   3,377  18.5 

1910 18,483,068                   3,428  18.5 

1911 18,672,360                   3,427  18.4 

1912 18,862,264                   3,736  19.8 

1908-1912 92,416,069                  17,189  18.6 

Source:     Annual  Reports  of  the  Registrar-General  of  Births,  Deaths  and  Marriages, 
in  England  and  Wales. 


601 


APPENDIX  G 

Table  15 

Comparative  Mortality  from  Cancer  in  England  and  Wales,  Urban  and 

Rural,  by  Organs  and  Parts,  according  to  Sex,  1911-1912 


TOTAL 

Urban 


Organ  or  Part 


Deaths 

from 
Cancer 


Buccal  cavity 3,677 

Stomach  and  liver 18,831 

Peritoneum,  intestines,  rectum.  .  .  10,733 

Female  generative  organs 7,527 

Breast 5,647 

Skin 1,345 

Other  or  not  specified 8,983 


Rate  per 

100,000 

Population 

6.5 
33.2 
18.9 
13.3 
9.9 
2.4 
15.8 


All  organs 56,743 

Buccal  ca\'ity 3,186 

Stomach  and  liver 9,784 

Peritoneum,  intestines,  rectum .  .  .  4,934 

Breast 32 

Skin 850 

Other  or  not  specified 5,594 


100.0 


MALES 


All  organs 24,380 


11.7 
36.0 
18.1 
0.1 
3.1 
20.6 

89.6 


FEMALES 


Buccal  cavity 491 

Stomach  and  liver 9,047 

Peritoneum,  intestines,  rectum..  .  5,799 

Generative  organs 7,527 

Breast 5,615 

Skin 495 

Other  or  not  specified 3,389 


All  organs 32,363 


1.7 
30.6 
19.6 
25.5 
19.0 

1.7 
11.4 

109.5 


POPULATION,  1911-1912 
Urban 

Males 27,195,707 

Females 29,562,270 


Total 56,757,977 


Rural 


Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

971 

6.1 

5,981 

37.5 

3,401 

21.3 

1,667 

10.5 

1,558 

9.8 

507 

3.2 

2,397 

15.0 

16,482 


3,070 

1,692 

10 

313 

1,486 

7,397 


145 
2,911 
1,709 
1,667 
1,548 
194 
911 

9.085 


Rural 
7,963,578 
7,972,354 

15,935,932 


103.4 


10.4 
38.6 
21.2 
0.1 
3.9 
18.7 

92.9 


1.8 
36.5 

21.4 
20.9 
19.4 
2.4 
11.4 

113.9 


Source:  Annual  Reports  of  the  Registrar-General  of  Births,  Deaths  and  Marriages 
in  England  and  Wales. 

Note:  If  standardized,  the  urban  cancer  death  rates  are  somewhat  higher  than  the 
rural  rates. 


602 


APPENDIX  G 

Table  15a 

Cancer  of  the  Ovary,  according  to  Age  and  Conjugal  Condition 

England  and  Wales,  1911-1913 


Ages  Unmarried 

25-29 0.9 

30-34 1.4 

35-39 3.7 

40-44 7.6 

45-49 14.2 

50-54 15.0 

55-59 21.8 

60-64 13.7 

65-69 17.4 

70-74 17.8 

75-79 21.1 

80-84 3.1 

85  and  over.  .        6.3 


15  and  over . 


6.0* 


ER  100,000 

Relative  Rates 

TION 

Ages  25-29  Taken  as  100 

Married  or 

Married  or 

Married  or 

Widowed 

Unmarried 

Widowed 

Unmarried 

Widowed 

0.7 

0.2 

100 

100 

1.0 

0.4 

156 

143 

2.1 

1.6 

411 

300 

3.5 

4.1 

844 

500 

5.9 

8.3 

1,578 

843 

8.3 

6.7 

1,667 

1,186 

8.6 

13.2 

2,422 

1,229 

9.7 

4.0 

1,522 

1,386 

10.5 

6.9 

1,933 

1,500 

9.4 

8.4 

1,978 

1,343 

9.0 

12.1 

2,344 

1,286 

6.0 

2.9 

344 

857 

4.6 

1.7 

700 

657 

3.1* 

2.9 

667 

443 

Source:     Seventy-sixth  Annual  Report  of  the  Registrar-General  of  Births,  Deaths  and 
Marriages  in  England  and  Wales. 

*Standardized  to  a  million  of  persons  aged  15  years  and  upwards,  1901. 

Table  15b 

Cancer  of  the  Uterus,  according  to  Age  and  Conjugal  Condition 

England  and  Wales,  1911-1913 


Death  Rate  per  100,000 
OF  Population 

Married  or 
Ages  Unmarried  Widowed 

25-29 0.7  2.0 

30-34 3.1  6.8 

35-39 5.0  18.7 

40-44 17.2  37.4 

45-49 25.0  58.1 

50-54 39.7  77.3 

55-59 61.3  87.3 

60-64 61.1  96.7 

65-69 64.6  97.0 

70-74 62.7  91.7 

75-79 84.4  92.8 

80-84 102.0  73.0 

85  and  over..  50.4  58.4 

15  and  over..      16.9*  29.3* 


Excess  in  Rates 


Unmarried 


29.0 


Married  or 
Widowed 

1.3 

3.7 
13.7 
20.2 
33.1 
37.6 
26.0 
35.6 
32.4 
29.0 

8.4 

8.6 
12.4 


Relative  Rates 
Ages  25-29  Taken  as  100 

Married  or 
Widowed 


Unmarried 

100 

443 

714 

2,457 

3,571 

5,671 

8,757 

8,729 

9,229 

8,957 

12,057 

14,571 

7,200 

2,414 


100 
340 
935 
1,870 
2,905 
3,865 
4,365 
4,835 
4,850 
4,585 
4,640 
3,650 
2,920 

1,465 


Source:     Seventy-sixth  Annual  Report  of  the  Registrar-General  of  Births,  Deaths  and 
Marriages  in  England  and  Wales. 

*Standardized  to  a  million  of  persons  aged  15  years  and  upwards,  1901. 


603 


APPENDIX  G 

Table  15c 

Cancer  of  the  Breast,  according  to  Age  and  Conjugal  Condition 

England  and  Wales,  1911-1913 


Death  Rate 

PER  100,000 

Excess 

IN  Rates 

Relative  Rates 

OF  Population 

Ages  25-29  Taken  as  100 

Married  or 

Married  or 

Married  or 

Ages 

Unmarried 

Widowed 

Unmarried 

Widowed 

Unmarried             Widowed 

25-29 

.       0.4 

0.7 

0.3 

100                  100 

30-34 

3.2 

4.1 

0.9 

800                 586 

35-39 

.      12.9 

12.6 

0.3 

3,225               1,800 

40-44 

.     29.9 

26.8 

3.1 

7,475               3,829 

45-49 

.     55.0 

41.8 

13.2 

13,750               5,971 

50-54 

.     75.5 

51.7 

23.8 

18,875               7,386 

55-59 

.   102.3 

65.7 

36.6 

25,575               9,386 

60-64 

.   118.9 

73.7 

45.2 

29,725             10,529 

65-69 

.   142.3 

81.2 

61.1. 

35,575             11,600 

70-74 

.   180.6 

111.7 

68.9 

45,150             15,957 

75-79 

.   200.5 

134.6 

65.9 

50,125             19,229 

80-84 

.   225.6 

156.2 

69.4 

56,400            22,314 

85  and  over . 

.   308.8 

191.6 

117.2 

77,200            27,371 

15  and  over . 

.     34.6* 

23.8* 

10.8 

8,650              3,400 

Source:     Seventy-sixth  Annual  Report  of  the  Registrar-General  of  Births,  Deaths  and 
Marriages  in  England  and  Wales. 

*Staiidardized  to  a  million  of  persons  aged  15  years  and  upwards,  1901. 

Table  15d 
Mortality  from  Cancer,  Fistula  and  Gangrene  in  the  City  of  London 

1649-1758 

Deaths  from 
Deaths  from  Cancer,  Fistula    Per  Cent,  of 

All  Causes  and  Gangrene       All  Causes 

1649-1658 117,344  370  0.32 

1659-1668* 132,972  466  0.35 

1669-1678 188,015  478  0.25 

1679-1688 221,446  597  0.27 

1701-1708 168,191  549  0.33 

1709-1718 231,714  702  0.30 

1719-1728 272,240  710  0.26 

1729-1738 265,165  564  0.21 

1739-1748 260,517  498  0.19 

1749-1758 214,406  460  0.21 

Source :      A   Collection   of   the   Yearly   Bills   of   Mortality   from    1657   to    1758, 
London,    1759. 

Note:     No  data  available  for  1689-1700. 
*Data  for  1665  and  1666  excluded.  Plague  years. 


604 


APPENDIX  G 


Table  16 

Table  17 

Mortality  from  Cancer  in  London 

Mortality  from  Cancer  in  London 

1881-1913 

Males 

- 

1881-1913 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 
100,000 
'opulation 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 
100,000 
j'opulation 

1881 

3,840,239 

2,332 

60.7 

1881 

1,808,753 

755 

41.7 

1882 

3,880,005 

2,461 

63.4 

1882 

1,828,258 

779 

42.6 

1883 

3,919,771 

2,561 

65.3 

1883 

1,847,388 

804 

43.5 

1884 

3,959,537 

2,604 

65.8 

1884 

1,866,922 

915 

49.0 

1885 

3,999,303 
19,598,855 

2,622 

65.6 
64.2 

1885 

1,886,072 

909 

48.2 

12,580 

1881-1885 

1881-1885 

9,237,393 

4,162 

45.1 

1886 

4,039,069 

2,688 

66.5 

1887 

4,078,835 

2,909 

71.3 

1886 

1,905,633 

967 

50.7 

1888 

4,118,601 

2,932 

71.2 

1887 

1,925,618 

1,089 

56.6 

1889 

4,158,367 

3,029 

72.8 

1888 

1,945,215 

1,058 

54.4 

1890 

4,198,133 

3,286 

78.3 

1889 
1890 

1,964,828 
1,984,038 

1.078 
1,194 

54.9 
60.2 

1886-1890 

20,593,005 

14,844 

72.1 

1886-1890 

9,725,332 

5,386 

55.4 

1891 

4,237,896 

3.342 

78.9 

1892 

4,268,727 

3,246 

76.0 

1891 

2,003,253 

1,233 

61.5 

1893 

4,299,558 

3,462 

80.5 

1892 

2,017,400 

1,242 

61.6 

1894 

4,330,389 

3,523 

81.4 

1893 

2,031,541 

1,280 

63.0 

1895 

4,361,220 

3,705 

85.0 

1894 

2,046,109 

1,354 

66.2 

1895 

2,060,240 

1,423 

69.1 

1891-1895 

21,497,790 

17,278 

80.4 

1891-1895 

10,158,543 

6,532 

64.3 

1896 

4,392,051 

3,856 

87.8 

1897 

4,422,882 

3,963 

89.6 

1896 

2,074,366 

1,523 

73.4 

1898 

4,453,713 

4,133 

92.8 

1897 

2,088,485 

1,617 

77.4 

1899 

4,484,544 

4,293 

95.7 

1898 

2,102,598 

1,658 

78.9 

1900 

4,515,375 

4,348 

96.3 

1899 

2,116,705 

1,741 

82.3 

1900 

2,130,805 

1,790 

84.0 

1896-1900 

22,268,565 

20,593 

92.5 

1896-1900 

10,512,959 

8,329 

79.2 

1901 

4,546,209 

4,260 

93.7 

1902 

4,544,878 

4,591 

101.0 

1901 

2,145,356 

1,704 

79.4 

1903 

4,543,547 

4,716 

103.8 

1902 

2,144,274 

1,932 

90.1 

1904 

4,542,216 

4,677 

103.0 

1903 

2,142,737 

2,000 

93.3 

1905 

4,540,885 

4,691 

103.3 

1904 

2,141,201 

1,988 

92.8 

1905 

2,139,665 

1,986 

92.8 

1901-1905 

22,717,735 

22,935 

101.0 

1901-1905 

10,713,233 

9,610 

89,7 

1906 

4,539,554 

5,001 

110.2 

1907 

4,538,223 

4,899 

107.9 

1906 

2,138,130 

2,196 

102.7 

1908 

4,536,892 

5,045 

111.2 

1907 

2,137,049 

2,184 

102.2 

1909 

4,535,561 

5,128 

113.1 

1908 

2,135,515 

2,253 

105.5 

1910 

4,534,230 

5,115 

112.8 

1909 

2,134,435 

2,261 

105.9 

1910 

2,132,902 

2,340 

109.7 

1906-1910 

22,684,460 

25,188 

111.0 

1906-1910 

10,678,031 

11,234 

105.2 

1911 

4,532,899 

4,858 

107.2 

1912 

4,531,572 

5,176 

114.2 

1911 

2,131,822 

2,265 

106.2 

1913 

4,530,245 

5,260 

114.9 

1912 

2,130,745 

2,272 

106.6 

c^„^„^. 

^^^,,c^T> ^^ 

„„4?4^T,„-D 

«™C^4-««« 

1913 

2,129,668 

2,318 

108.8 

General  of  Births,  Deaths  and  Marriages 
in  England  and  Wales.  Annual  Report  of 
the  London  County  Counsel,  1913. 


Source :  Annual  Reports  of  the  Registrar- 
General  of  Births,  Deaths  and  Marriages 
in  England  and  Wales. 


605 


APPENDIX  G 

Table  18 

Mortality  from  Cancer  in  London,  Females 

1881-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer  Population 

Cancer 

Population 

1881 

2,031,486 

1,577 

77.6 

1906 

2,401,424 

2,805 

116.8 

1882 

2,051,747 

1,682 

82.0 

1907 

2,401,174 

2,715 

113.1 

1883 

2,072,383 

1,757 

84.8 

1908 

2,401,377 

2,792 

116.3 

1884 

2,092,615 

1,689 

80.7 

1909 

2,401,126 

2,867 

119.4 

1885 

2,113,231 

1,713 

81.1 

81.2 

1910 
1906-1910 

2,401,328 

2,775 

115.6 

1881-1885 

10,361,462 

8,418 

12,006,429 

13,954 

116.2 

1886 

2,133,436 

1,721 

80.7 

1911 

2,401,077 

2,593 

108.0 

1887 

2,153,217 

1,820 

84.5 

1912 

2,400,827 

2,904 

121.0 

1888 

2,173,386 

1,874 

86.2 

1913 

2,400,577 

2,942 

122.6 

1889 

2,193,539 

1,951 

88.9 

1890 

2,214,095 

2,092 

94.5 

Source: 

Annual  Reports  of  the  Registrar- 

General  of  Births,  Deaths  and  IV 

larriages 

1886-1890 

10,867,673 

9,458 

87.0 

in  England  and  Wales. 

1891 

2,234,643 

2,109 

94.4 

1892 

2,251,327 

2,004 

89.0 

1893 

2,268,017 

2,182 

96.2 

1894 

2,284,280 

2,169 

95.0 

1895 

2,300,980 

2,282 

99.2 
94.8 

1891-1895 

11,339,247 

10,746 

1896 

2,317,685 

2,333 

100.7 

1897 

2,334,397 

2,346 

100.5 

1898 

2,351,115 

2,475 

105.3 

1899 

2,367,839 

2,552 

107.8 

1900 

2,384,570 

2,558 

107.3 
104.3 

• 

1896-1900 

11,755,606 

12,264 

1901 

2,400,853 

2,556 

106.5 

1902 

2,400,604 

2,659 

110.8 

1903 

2,400,810 

2,716 

113.1 

1904 

2,401,015 

2,689 

112.0 

1905 

2,401,220 

2,705 

112.7 
111.0 

1901-1905 

12,004,502 

13,325 

606 


APPENDIX  G 

Table  19 

Mortality  from  Cancer  in  Sheffield 

1887-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1887 

308,730 

146 

47.3 

1901 

410,151 

255 

62.2 

1888 

312,793 

135 

43.2 

1902 

414,506 

300 

72.4 

1889 

316,901 

163 

51.4 

1903 

418,906 

303 

72.3 

1890 

321,079 

156 

48.6 

1904 

423,355 

317 

74.9 

1905 

427,850 

290 

67.8 

1887-1890 

1,259,503 

600 

47.6 

1901-1905 

2,094,768 

1,465 

69.9 

1891 

325,547 

150 

46.1 

1892 

330,816 

154 

46.6 

1906 

432,395 

346 

80.0 

1893 

336,171 

184 

54.7 

1907 

436,986 

363 

83.1 

1894 

341,612 

207 

60.6 

1908 

441,630 

347 

78.6 

1895 

347,141 

208 

59.9 

1909 

446,321 

403 

90.3 

1910 

451,065 

394 

87.3 

1891-1895 

1,681,287 

903 

53.7 

1906-1910 

2,208,397 

1,853 

83.9 

1896 

352,760 

225 

63.8 

1897 

358,470 

233 

65.0 

1911 

455,817 

379 

83.1 

1898 

364,272 

244 

67.0 

1912 

466,408 

371 

79.5 

1899 

370,168 

228 

61.6 

1913 

471,662 

419 

88.8 

1900 

376,160 

284 

75.5 

Source: 

Annual  Reports  of  the  Health 

1896-1900 

1,821,830 

1,214 

66.6 

of  the  City  of  Sheffield. 

Table  20 

Mortality  from  Cancer  in  Sheffield,  Males 

1887-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1887 

153,871 

43 

27.9 

1901 

204,419 

121 

59.2 

1888 

155,896 

42 

26.9 

1902 

206,590 

115 

55.7 

1889 

157,943 

56 

35.5 

1903 

208,573 

127 

60.9 

1890 

160,026 

52 

32.5 

1904 
1905 

210,577 
212,599 

137 
108 

65.1 

50.8 

1887-1890 

627,736 

193 

30.7 

1901-1905 

1,042,758 

608 

58.3 

1891 

162,253 

58 

35.7 

1892 

164,879 

64 

38.8 

1906 

214,641 

155 

72.2 

1893 

167,548 

57 

34.0 

1907 

216,701 

151 

69.7 

1894 

170,259 

79 

46.4 

1908 

218,784 

162 

74.0 

1895 

173,015 

76 

43.9 

1909 
1910 

220,884 
223,007 

167 

172 

75.6 

leqi.iQQs 

837,954 

334 

39.9 

1906-1910 

1,094,017 

807 

73.8 

1896 

175,816 

84 

47.8 

1897 

178,661 

96 

53.7 

1911 

225,037 

179 

79.5 

1898 

181,553 

81 

44.6 

1912 

230,266 

177 

76.9 

1899 

184,492 

96 

52.0 

1913 

232,860 

172 

73.9 

1900 

187,478 

114 

60.8 

Source: 

Annual  Reports  of  t 

1896-1900 

908,000 

471 

51.9 

of  the  City  of  Sheffield. 

40 


607 


APPENDIX  G 

Table  21 

Mortality  from  Cancer  in  Sheffield,  Females 

1887-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1887 

154,859 

103 

66.5 

1901 

205,732 

134 

65.1 

1888 

156,897 

93 

59.3 

1902 

207,916 

185 

89.0 

1889 

158,958 

107 

67.3 

1903 

210,333 

176 

83.7 

1890 

161,053 

104 

64.6 

1904 

212,778 

180 

84.6 

1905 

215,251 

182 

84.6 

1887-1890 

631,767 

407 

64.4 

1901-1905 

1,052,010 

857 

81.5 

1891 

163,294 

92 

56.3 

1892 

165,937 

90 

54.2 

1906 

217,754 

191 

87.7 

1893 

168,623 

127 

75.3 

1907 

220,285 

212 

96.2 

1894 

171,353 

128 

74.7 

1908 

222,846 

185 

83.0 

1895 

174,126 

132 

75.8 

1909 

225,437 

236 

104.7 

1910 

228,058 

222 

97.3 

1891-1895 

843,333 

569 

67.5 

1906-1910 

1,114,380 

1,046 

93.9 

1896 

176,944 

141 

79.7 

1897 

179,809 

137 

76.2 

1911 

230,780 

200 

86.7 

1898 

182,719 

163 

89.2 

1912 

236,142 

194 

82.2 

1899 

185,676 

132 

71.1 

1913 

238,802 

247 

103.4 

1900 

188,682 

170 

90.1 

Source: 

Annual  Reports  of  the  Health 

1896-1900 

913,830 

743 

81.3 

of  the  City 

of  Sheffield. 

Table  22 
Mortality  from  Cancer  in  Liverpool 
1889-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Catocer 

Population 

1889 

523,838 

291 

55.6 

1901 

686,332 

593 

86.4 

1890 

520,466 

334 

64.2 

1902 

707,027 

613 

86.7 

1903 

710,874 

661 

93.0 

1891 

518,302 

346 

66.8 

1904 

714,743 

546 

76.4 

1892 
1893 

519,590 

520,882 

303 
341 

58.3 
65.5 

1905 

721,864 

620 

85.9 

1894 

522,178 

345 

66.1 

1901-1905 

3,540,840 

3,033 

•85.7 

1895 

652,523 

502 

76.9 

1906 
1907 

726,100 
730,361 

678 

93  4 

1891-1895 

2,733,475 

1,837 

67.2 

684 

93.7 

1908 

734,648 

658 

89.6 

1896 

658,050 

495 

75.2 

1909 

738,960 

694 

93.9 

1897 

663,633 

514 

77.5 

1910 

743,295 

745 

100.2 

1898 

669,243 

495 

74.0 

1899 

674,912 

530 

78.5 

1906-1910 

3,673,364 

3,459 

94.2 

1900 

680,628 

526 

77.3 

1911 
1912 

747,627 
752,021 

726 
769 

97  1 

1896-1900 

3,340,466 

2,500 

76.5 

102.3 

1913 

756,553 

717 

94.8 

Source: 

Annual  Reports  on  the  Health  of 

the  City  of  Liverpool. 

608 


APPENDIX  G 

Table  23 

Mortality  from  Cancer  in  Liverpool,  Males 

1889-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1889 

254,166 

121 

47.6 

1901 

331,361 

246 

74.2 

1890 

252,478 

122 

48.3 

1902 

341,070 

258 

75.6 

1903 

342,712 

269 

78.5 

1891 

251,376 

135 

53.7 

1904 

344,363 

235 

68.2 

1892 

251,897 

122 

48.4 

1905 

347,578 

278 

80.0 

1893 

252,419 

124 

49.1 

1894 

252,943 

136 

53.8 

1901-1905 

1,707,084 

1,286 

75.3 

1895 

315,886 

215 

68.1 

1906 

349,399 

282 

80.7 

1891-1895 

1,324,521 

732 

55.3 

1907 

351,231 

280 

79.7 

1908 

353,072 

298 

84.4 

1896 

318,430 

203 

63.8 

1909 

354,922 

287 

80.9 

1897 

320,999 

190 

59.2 

1910 

356,782 

342 

95.9 

1898 
1899 

323,579 
326,185 

210 

222 

64.9 
68.1 

1906-1910 

1,765,406 

1,489 

84.3 

1900 

328,811 

187 

56.9 

1911 

358,637 

329 

91.7 

1896-1900 

1,618.004 

1,012 

62.5 

1912 

360,519 

371 

102.9 

1913 

362,470 

347 

95.7 

Source:  , 

Annual  Reports  on  the  Health 

of  the  City 

of  Liverpool. 

Table  24 

Mortality  from  Cancer  in  Liverpool,  Females 

1889-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Caincer 

Population 

Cancer 

Population 

1889 

269,672 

170 

63.0 

1901 

354,971 

347 

97.8 

1890 

267,988 

212 

79.1 

1902 

365,957 

355 

97.0 

1903 

368,162 

392 

106.5 

1891 

266,926 

211 

79.0 

1904 

370,380 

311 

84.0 

1892 

267,693 

181 

67.6 

1905 

374,286 

342 

91.4 

1893 
1894 

268,463 
269,235 

217 
209 

80.8 
77.6 

1901-1905 

1,833,756 

1,747 

95.3 

1895 

336,637 

287 

85.3 

1906 

376,701 

396 

105.1 

1891-1895 

1,408,954 

1,105 

78.4 

1907 

379,130 

404 

106.6 

1908 

381,576 

360 

94.3 

1896 

339,620 

292 

86.0 

1909 

384,038 

407 

106.0 

1897 

342,634 

324 

94.6 

1910 

386,513 

403 

104.3 

1898 
1899 

345,664 

348,727 

285 
308 

82.5 
88.3 

1906-1910 

1,907,958 

1,970 

103.3 

1900 

351,817 

339 

96.4 

1911 

388,990 

397 

102.1 

1896-1900 

1,728,462 

1,548 

89.6 

1912 

391,502 

398 

101.7 

1913 

394,083 

370 

93.9 

Source: 

A.nnual  Reports  on  the  Health 

of  the  City 

of  Liverpool. 

609 


APPENDIX  G 

Table  25 

Mortality  from  Cancer  in  Birmingham 

1891-1912 


Deaths 

Rate  per 

' 

Deaths 

Eate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1891 

479,193 

324 

67.6 

1906 

523,586 

460 

87.9 

1892 

483,526 

293 

60.6 

1907 

523,850 

419 

80.0 

1893 

487,897 

313 

64.2 

1908 

524,114 

441 

84.1 

1894 

492,301 

303 

61.5 

1909 

524,378 

424 

80.9 

1895 

496,751 

332 

66.8 
64.1 

1910 
1906-1910 

525,762 

469 

89.2 

1891-1895 

2,439,668 

1,565 

2,621,690 

2,213 

84.4 

1896 

501,241 

346 

69.0 

1911 

526,030 

467 

88.8 

1897 

505,772 

376 

74.3 

1912 

850,947 

792 

93.1 

1898 

510,343 

342 

67.0 

1899 

514,956 

386 

75.0 

Source: 

Annual  Reports  of  the  Medical 

1900 

519,610 

368 

70.8 
71.2 

Officer  of  Health  for  Birmingha 

01. 

1896-1900 

2,551,922 

1,818 

1901 

522,270 

395 

75.6 

1902 

522,533 

383 

73.3 

1903 

522,796 

413 

79.0 

1904 

523,059 

400 

76.5 

1905 

523,323 

437 

83.5 

77.6 

1901-1905 

2,613,981 

2,028 

Table  26 

Mortality  from  Cancer  in  Birmingham,  by  Sex 

1904-1912 


MALES 

FEMALES 

Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1904 

252,481 

172 

68.1 

1904 

270,578 

228 

84.3 

1905 

252,608 

186 

73.6 

1905 

270,715 

251 

92.7 

1906 

252,735 

210 

83.1 

1906 

270,851 

250 

92.3 

1907 

252,862 

168 

66.4 

1907 

270,988 

251 

92.6 

1908 

252,990 

193 

76.3 

1908 

271,124 

248 

91.5 

1909 

253,117 

170 

67.2 

1909 

271,261 

254 

93.6 

1910 

253,785 

236 

93.0 

77.2 

1910 
1906-1910 

271,977 

233 

85.7 

1906-1910 

1,265,489 

977 

1,356,201 

1,236 

91.1 

1911 

253,915 

184 

72.5 

1911 

272,115 

283 

104.0 

1912 

405,646 

349 

86.0 

1912 

445,301 

443 

99.3 

Source: 

Annual  Reports  of  the  Medical 

Officer  of  Health  for  Birmingham 

610 


APPENDIX  G 

Table  27 

Mortality  from  Cancer  in  Leeds 

1893-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1893 

381,157 

229 

60.1 

1906 

437,683 

432 

98.7 

1894 

387,259 

265 

68.4 

1907 

439,343 

415 

94.5 

1895 

393,387 

299 

76.0 

1908 

441,003 

463 

105.0 

1909 

442,663 

449 

101.4 

1896 
1897 

399,535 
405,716 

308 
308 

77.1 
75.9 

1910 

444,323 

447 

100.6 

1898 

411,895 

292 

70.9 

1906-1910 

2,205,015 

2,206 

100.0 

1899 

418,101 

317 

75.8 

1900 

424,322 

369 

87.0 

1911 

445,983 

476 

106.7 

1912 
1913 

447,746 

457,295 

473 

105  6 

1896-1900 

2,059,569 

1,594 

77.4 

509 

111.3 

1901 

429,383 

348 

81.0 

Source: 

Annual   Reports  made   to  the 

1902 

431,043 

353 

81.9 

Urban  Sanitary  Authority  of  the  City  of 

1903 

432,703 

406 

93.8 

Leeds. 

1904 

434,363 

379 

87.3 

1905 

436,023 

444 

101.8 
89.2 

1901-1905 

2,163,515 

1,930 

Table  28 

Mortality  from  Cancer  in  Bristol 

1894-1913 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1894 

228,027 

183 

80.3 

1906 

354,329 

307 

86.6 

1895 

231,026 

208 

90.0 

1907 

354,965 

317 

89.3 

1896 
1897 
1898 

234,025 
237,024 
323,824 

201 
212 
243 

85.9 
89.4 
75.0 

1908 
1909 
1910 

355,601 
356,237 
356,873 

306 
357 
340 

86.1 

100.2 

95.3 

1899 
1900 

327,825 
332,076 

289 
266 

88.2 
80.1 

1906-1910 

1,778,005 

1,627 

91.5 

1896-1900 

1,454,774 

1,211 

83.2 

1911 
1912 

357,509 
359,400 

387 
402 

108.2 
111.9 

1901 

339,042 

259 

76.4 

1913 

361,362 

396 

109.6 

1902 
1903 
1904 

339,344 
339,646 
339,948 

291 
281 
285 

85.8 
82.7 
83.8 

Source:  Annual  Reports  of  the  Medical 
Officer  of  Health  of  Bristol. 

1905 

353,693 

313 

88.5 
83.5 

1901-1905 

1,711,673 

1,429 

611 


APPENDIX  G 


Table  29 

Table  30 

Mortality  from  Cancer  in 

Man- 

Mortality  from  Cancer  in 

Man- 

Chester,  1891-1912 

Chester, 

Males 

1891-1912 

Population 

Deaths 
from 

Rate  per 
100,000 

Year 

Cancer 

Population 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

1891 

508,673 

321 

63.1 

Cancer 

Population 

1892 

513,196 

312 

60.8 

1891 

245,486 

119 

48.5 

1893 

517,760 

303 

58.5 

1892 

247,514 

105 

42.4 

1894 

522,365 

344 

65.9 

1893 

249,612 

121 

48.5 

1895 

527,010 

334 

63.4 

1894 

251,728 

124 

49.3 

1895 

253,861 

116 

45.7 

1891-1895 

2,589,004 

1,614 

62.3 

1891-1895 

1,248,201 

585 

46.9 

1896 

531,697 

358 

67.3 

1897 

536,426 

396 

73.8 

1896 

256,012 

125 

48.8 

1898 

541,296 

394 

72.8 

1897 

258,081 

152 

58.9 

1899 

546,010 

408 

74.7 

1898 

260,418 

164 

63.0 

1900 

542,566 

412 

75.9 

1899 

262,576 

144 

54.8 

1900 

260,811 

156 

59.8 

1896-1900 

2,697,995 

1,968 

72.9 

1896-1900 

1,297,898 

741 

57.1 

1901 

546,408 

425 

77.8 

1902 

550,355 

435 

79.0 

1901 

262,549 

180 

68.6 

1903 

554,331 

424 

76.5 

1902 

264,336 

185 

70.0 

1904 

558,335 

452 

81.0 

1903 

268,352 

185 

68.9 

1905 

631,933 

546 

86.4 

1904 

270,275 

192 

71.0 

1905 

303,067 

238 

78.5 

1901-1905 

2,841,362 

2,282 

80.3 

1901-1905 

1,368,579 

980 

71.6 

1906 

646,066 

562 

87.0 

1907 

660,199 

498 

75.4 

1906 

309,853 

242 

78.1 

1908 

674,332 

584 

86.6 

1907 

316,631 

206 

65.1 

1909 

688,466 

606 

88.0 

1908 

323,410 

267 

82.6 

1910 

702,600 

660 

93.9 

1909 

330,188 

266 

80.6 

1910 

336,967 

307 

91,1 

1906-1910 

3,371,663 

2,910 

86.3 

1906-1910 

1,617.049 

1,288 

79.7 

1911 

716,734 

750 

104.6 

1912 

730,868 

721 

98.6 

1911 

344,490 

332 

96.4 

1912 

350,524 

309 

88.2 

Source: 

Annual  Reports  on  the  Health 

of  the  City  of  Manchester. 

Source: 

Annual  Reports  on  the  Health 

of  the  City  of  Manchester. 

612 


APPENDIX  G 


Table  31 
Mortality  from  Cancer  in  Man- 
chester, Females 
1891-1912 


Year 

1891 
1892 
1893 
1894 
1895 


Population 

263,187 
265,682 
268,148 
270,637 
273.149 


1891-1895  1,340,803 


1896 
1897 
1898 
1899 
1900 


275,685 
278,345 
280,878 
283,434 
281,755 


Deaths 
from 
Cancer 

202 
207 
182 
220 
218 

1,029 

233 
244 
230 
264 
256 


1896-1900  1,400,097    1,227 


1901 
1902 
1903 
1904 
1905 


283,859 
286,019 
285,979 
288,060 
328,866 


245 
250 
239 
260 
308 


1901-1905  1,472,783 

1906  336,213 

1907  343,568 

1908  350,922 

1909  358,278 

1910  365,633 


1,302 

320 
292 
317 
340 
353 


1906-1910     1,754,614         1,622 


1911 
1912 


372,244 
380,344 


418 
412 


Rate  per 

100,000 

Population 

76.8 
77.9 
67.9 
81.3 
79.8 

76.7 

84.5 
87.7 
81.9 
93.1 
90.9 

87.6 

86.3 
87.4 
83.6 
90.3 
93.7 


95.2 
85.0 
90.3 
94.9 
96.5 

92.4 

112.3 
108.3 


Source:  Annual  Reports  on  the  Health 
of  the  City  of  Manchester. 


Table  32 

Mortality  from  Cancer  in  Scotland 

1881-1912 


Year 


1881 


1883 
1884 
1885 


Population 

3,742,564 
3,770,657 
3,798,961 
3,827,478 
3,856,207 


1886 
1887 
1888 
1889 
1890 


3,885,155 
3,914,318 
3,943,701 
3,973,305 
4,003,132 


1891 
1892 
1893 
1894 
1895 


4,036,245 
4,078,910 
4,122,029 
4,165,606 
4,209,645 


1896 
1897 
1898 
1899 
1900 


4,254,153 
4,299,132 
4,344,589 
4,390,530 
4,436,958 


1901 
1902 
1903 
1904 
1905 


4,479,065 
4,507,048 
4,535,201 
4,563,530 
4,592,036 


1906 
1907 
1908 
1909 
1910 


4,620,720 
4,649,586 
4,678,629 
4,707,858 
4,737,268 


1911 
1912 


4,766,678 
4,796,088 


Deaths 
from 

Cancer 

1,914 
2,056 
2,037 
2,110 
2,173 


1881-1885  18,995,867       10,290 


2,313 
2,373 
2,450 
2,643 

2,428 


1886-1890  19,719,611       12,207 


2,703 
2,715 
2,816 
2,928 
2,993 


1891-1895  20,612,435       14,155 


3,013 
3,212 
3,453 
3,572 
3,503 


1896-1900  21,725,362       16,753 


3,662 
3,711 
3,798 
3,920 
4,132 


1901-1905  22,676,880       19,223 


4,509 
4,551 
4,611 

4,782 
4,863 


1906-1910  23,394,061       23,316 


4,948 
5,195 


Rate  per 

100,000 

Population 

51.1 
54.5 
53.6 
55.1 
56.4 

54.2 

59.5 
60.6 
62.1 
66.5 
60.7 

61.9 

67.0 
66.6 
68.3 
70.3 
•    71.1 

68.7 

70.8 
74.7 
79.5 
81.4 
79.0 

77.1 

81.8 
82.3 
83.7 
85.9 
90.0 

84.8 

97.6 

97.9 

98.6 

101.6 

102.7 

99.7 

103.8 
108.3 


Source:  Annual  Reports  of  the  Registrar- 
General  on  the  Births,  Deaths  and  Mar- 
riages registered  in  Scotland. 


613 


APPENDIX  G 


Table  33 

Mortality  from  Cancer  in  Scotland,  by  Sex 

1906-1912 


MALES 

FEMALES 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1906 
1907 
1908 
1909 
1910 

2,241,049 
2,255,049 
2,269,135 
2,283,311 

2,297,575 

1,785 
1,786 
1,816 
1,887 
1,953 

79.7 
79.2 
80.0 
82.6 
85.0 

81.3 

1906 
1907 
1908 
1909 
1910 

1906-1910 

2,379,671 
2,394,537 
2,409,494 
2,424,547 
2,439,693 

2,724 
2,765 
2,795 
2,895 
2,910 

114.5 
115.5 
116.0 
119.4 
119.3 

1906-1910 

11,346,119 

9,227 

12,047,942 

14,089 

116.9 

1911 
1912 

2,311,839 
2,326,103 

2.046 
2,075 

88.5 
89.2 

1911 
1912 

2,454,839 
2,469,985 

2,902 
3,120 

118.2 
126.3 

Source:  Annual  Reports  of  the  Registrar- 
General  on  the  Births,  Deaths  and  Mar- 
riages registered  in  Scotland. 

Table  34 
Mortality  from  Cancer  in  Scotland,  by  Organs  and  Parts,  according  to  Sex 

•       1906-1910 


Organ  or  Part 


from 
Cancer 

Lips 125 

Mouth 97 

Tongue 457 

Jaw 278 

Pharynx  and  throat 200 

Larynx 154 

Lungs 151 

(Esophagus 354 

Stomach 2,471 

Pancreas 131 

Liver 985 

Rectiun 651 

Other  intestines 1,102 

Peritoneum 82 

Kidney 86 

Bladder  and  urethra 227 

Breast 18 

Male  generative  organs 234 

Uterus 

Ovary 

Other  organs 1,138 

Not  specified 286 


MALES 
Deaths  Rate  per 

100,000 
Population 

1.10 
0.85 
4.03 
2.45 
1.76 
1.36 
1.33 
3.12 
21.78 
1.15 
8.68 
5.74 
9.71 
0.72 
0.76 
2.00 
0.16 
2.06 


10.03 
2..52 


81.32 


FEMALES 

Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

16 

0.13 

26 

0.22 

63 

0.52 

88 

0.73 

73 

0.61 

58 

0.48 

121 

1.00 

183 

1.52 

2,769 

22.98 

165 

1.37 

1,655 

13.74 

630 

5.23 

],708 

14.18 

176 

1.46 

88 

0.73 

124 

1.03 

1,856 

15.41 

2,262 

18.77 

217 

1.80 

1,388 

11.52 

423 

3.51 

14,089 


116.94 


All  organs 9,227 

Source:    Detailed  Annual  Reports  of  the  Registrar-General  of  Births,  Deaths  and  Mar- 
riages in  Scotland. 


614 


APPENDIX  G 

Table  35 

Mortality  from  Cancer  in  Scotland 

Relative  Mortality  of  Females,  by  Organs  and  Parts 

1906-1910 


Rate  per  100,000  Population 

Organ  or  Part  Males  Females 

Breast 0.16  15.41 

Generative  organs 2.06  20.57 

Peritoneum 0.72  1.46 

Liver 8.68  13.74 

Other  intestines 9.71  14.18 

Pancreas 1.15  1.37 

Stomach 21.78  22.98 

Kidney 0.76  0.73 

Rectum 5.74  5.23 

Lungs 1.33  1.00 

Bladder  and  urethra 2.00  1.03 

(Esophagus 3.12  1.52 

Pharynx  and  throat 1.76  0.61 

Larynx 1.36  0.48 

Jaw 2.45  0.73 

Mouth 0.85  0.22 

Tongue 4.03  0.52 

Lips 1.10  0.13 

All  organs 81.32  116.94 


Relative  Mortality 
of  Females 

9,631 
999 


158 

146 

119 

106 

96 

91 

75 

52 

49 

35 

35 

30 

26 

13 

12 

144 


Note:     In  this  table  the  mortality  of  males  from  cancer  of  any  organ  or  part  is  taken 
as  100  and  the  corresponding  mortality  of  females  is  given  accordingly. 


Table  36 

Mortality  from  Cancer  in  Aberdeen 

1899-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1899 

151,425 

145 

95.8 

1906 

158,698 

141 

88.8 

1900 

152,464 

132 

86.6 

1907 

159,737 

181 

113.3 

1908 

160,776 

178 

110.7 

1901 

153,503 

146 

95.1 

1909 

161,815 

182 

112.5 

1902 

154,542 

138 

89.3 

1910 

162,854 

161 

98.9 

IQO^ 

155,581 
156,620 

133 
163 

85.5 
104.1 

1904 

1906-1910 

803,880 

843 

104.9 

1905 

157,659 

145 

92.0 

1911 

163,891 

201 

122.6 

1901-1905 

777,905 

725 

93.2 

1912 

164,932 

219 

132.8 

1913 

165,073 

237 

143.6 

Source: 

Annual  Reports  by  the  Medical 

OflBcer  of  Health  for  Aberdeen. 

615 


APPENDIX  G 


Table  37 
Mortality  from  Cancer  in  the  City  of  Edinburgh 

1898-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

"iear 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1898 

301,305 

267 

88.6 

1906 

319,120 

330 

103.4 

1899 

305,468 

276 

90.4 

1907 

319,464 

344 

107.7 

1900 

309,688 

297 

95.9 

1908 

319,809 

353 

110.4 

1909 

320,282 

373 

116.5 

1901 

316,921 

293 

92.5 

1910 

320,504 

387 

120.7 

1902 
1903 

317,880 
318,219 

312 
316 

98.2 
99.3 

1906-1910 

1,599,179 

1,787 

111.7 

1904 

318,560 

331 

103.9 

1905 

318,777 

344 

107.9 

1911 

320,829 

405 

126.2 

1912 

321,119 

400 

124.6 

1901-1905 

1,590,357 

1,596 

100.4 

1913 

321,645 

401 

124.7 

Source: 

Annual  Reports  of  the  Public 

Health  Department  of  the  City  of  Edin- 

burgh. 

Table  38 

Mortality  from  Cancer  in  the  City  of  Edinburgh,  Males 

1898-1913 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1898 

137,696 

104 

75.5 

1906 

144,210 

132 

91.5 

1899 

139,477 

112 

80.3 

1907 

144,110 

120 

83.3 

1900 

141,280 

116 

82.1 

1908 

144,010 

123 

85.4 

1909 

143,967 

130 

90.3 

1901 

144,421 

110 

76.2 

1910 

143,810 

167 

116.1 

1902 
1903 

144,635 
144,567 

127 
130 

87.8 
89.9 

1906-1910 

720,107 

672 

93.3 

1904 

144,499 

125 

86.5 

1905 

144,374 

124 

85.9 

1911 

143,667 

154 

107.2 

1912 

144,118 

139 

96.4 

1901-1905 

722,496 

616 

85.3 

1913 

144,354 

146 

101.1 

Source:    Annual  Reports  of  the  Public 
Health  Department  of  the  City  of  Edin- 
burgh. 

616 


APPENDIX  G 

Table  39 

Mortality  from  Cancer  in  the  City  of  Edinburgh,  Females 

1898-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1898 

163,609 

163 

99.6 

1906 

174,910 

198 

113.2 

1899 

165,991 

164 

98.8 

1907 

175,354 

224 

127.7 

1900 

168,408 

181 

107.5 

1908 

175,799 

230 

130.8 

1909 

176,315 

243 

137.8 

1901 

172,500 

183 

106.1 

1910 

176,694 

220 

124.5 

1902 

173,245 

185 

106.8 

1903 

173,652 

186 

107.1 

1906-1910 

879,072 

1,115 

126.8 

1904 

174,061 

206 

118.3 

1905 

174,403 

220 

126.1 

1911 

177,162 

251 

141.7 

1912 

177,001 

261 

147.5 

1901-1905 

867,861 

980 

112.9 

1913 

177,291 

255 

143.8 

Source: 

Annual  Reports  of  the  Public 

Health  Department  of  the  City  of  Edin- 

burgh. 

Table  40 

Mortality  from  Cancer  in  Glasgow 

1881-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

511,914 

239 

46.7 

1901 

775,594 

571 

73.6 

1882 

513,915 

252 

49.0 

1902 

776,484 

649 

83.6 

1883 

515,924 

236 

45.7 

1903 

777,374 

624 

80.3 

1884 

517,941 

274 

52.9 

1904 

778,264 

650 

83.5 

1885 

519,965 

266 

51.2 
49.1 

1905 
1901-1905 

779,154 

693 

86.9 

1881-1885 

2,579,659 

1,267 

3,886,870 

3,187 

82.0 

1886 

521,999 

270 

51.7 

1906 

780,044 

803* 

102.9 

1887 

524,039 

275 

52.5 

1907 

780,934 

818* 

104.7 

1888 

526,088 

287 

54.6 

1908 

781,824 

801* 

102.5 

1889 

555,811 

337 

60.6 

1909 

782,714 

840* 

107.3 

1890 

561,561 

314 

55.9 
55.1 

1910 
1906-1910 

783,605 

896* 

114.3 

1886-1890 

2,689,498 

1,483 

3,909,121 

4,158* 

106.4 

1891 

567,272 

339 

59.8 

1911 

784,496 

809 

103.1 

1892 

669,059 

410 

61.3 

1912 

785,600 

844 

107.4 

1893 

677,883 

437 

64.5 

1913 

1,029,478 

971 

94.3 

1894 

686,820 

472 

68.7 

1895 

695,876 

462 

66.4 

Source:  Annual  Reports  of  the  Registrar- 

General  on 

rifntVio    anrl     Mar- 

1891-1895 

3,296,910 

2,120 

64.3 

riages  registered  in  Scotland. 

1881-1908,  Communications  Statistiques 

1896 

705,052 

470 

66.7 

pubUees  par  le  Bureau  Municipal  de  Statis- 

1897 

714,919 

521 

72.9 

tique  d'Amsterdam,  No 

33. 

1898 

724,349 

525 

72.5 

*Deaths  of 

non-residjnts  included,  1906-1910. 

1899 

742,194 

612 

82.5 

1900 

753,494 

565 

75.0 
74.0 

1896-1900 

3,640,008 

2,693 

617 


APPENDIX  G 

Table  41 

Mortality  from  Cancer  in  Ireland 

1881-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year             Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

5,145,770 

1,909 

37.1 

1906          4,397,571 

3,481 

79.2 

1882 

5,101,018 

1,882 

36.9 

1907          4,388,451 

3,338 

76.1 

1883 

5,023,811 

1,995 

39.7 

1908          4,384,664 

3,314 

75.6 

1884 

4,974,561 

1,947 

39.1 

1909          4,386,601 

3,502 

79.8 

1885 

4,938,588 

1,925 

39.0 
38.4 

1910          4,385,421 

3,664 

83.5 

1881-1885 

25,183,748 

9,658 

1906-1910  21,942,708 

17,299 

78.8 

1886 

4,905,895 

2,029 

41.4 

1911         4,383,608 

3,582 

81.7 

1887 

4,857,119 

2,067 

42.6 

1912         4,384,710 

3,734 

85.2 

1888 

4,801,312 

2,003 

41.7 

1889 

4,757,385 

2,134 

44.9 

Source :    Detailed  Annual  Reports  of  the 

1890 

4,717,959 

2,145 

45.5 

Registrar-General    for 

Ireland 

on    Mar- 

riages.  Births  and  Deaths. 

1886-1890 

24,039,670 

10,378 

43.2 

1891 

4,680,376 

2,163 

46.2 

1892 

4,633,808 

2,221 

47.9 

1893 

4,607,462 

2,280 

49.5 

1894 

4,589,260 

2,375 

51.8 

1895 

4,559,936 

2,296 

50.4 
49.1 

1891-1895 

23,070,842 

11,335 

1896 

4,542,061 

2,437 

53.7 

1897 

4,529,917 

2,635 

58.2 

1898 

4,518,478 

2,657 

58.8 

1899 

4,502,401 

2,654 

58.9 

1900 

4,468,501 

2,717 
13,100 

60.8 
58.1 

1896-1900  22,561,358 

1901 

4,447,085 

2,893 

65.1 

1902 

4,434,551 

2,861 

64.5 

1903 

4,417,757 

3,048 

69.0 

1904 

4,408,103 

3,055 

69.3 

1905 

4,399,308 

3,291 

74.8 
68.5 

1901-1905 

22,106,804 

15,148 

618 


APPENDIX  G 

Table  42 

Mortality  from  Cancer  in  Ireland,  Males 

1893-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1893 

2,268,440 

1,052 

46.4 

1906 

2,186,778 

1,566 

71.6 

1894 

2,259,919 

1,066 

47.2 

1907 

2,183,051 

1,530 

70.1 

1895 

2,247,303 

995 

44.3 

1908 

2,184,127 

1,527 

69.9 

1909 

2,187,792 

1,631 

74.6 

1896 

2,239,138 

1,100 

49.1 

1910 

2,188,271 

1,712 

78.2 

1897 

2,234,205 
2,229,701 

1,214 
1,238 

54.3 
55.5 

1898 

1906-1910 

10,930,019 

7,966 

72.9 

1899 

2,221,965 

1,193 

53.7 

1900 

2,204,921 

1,212 

55.0 

1911 

1912 

2,188,155 
2,189,429 

1,778 
1,768 

81.3 

1896-1900 

11,129,930 

5,957 

53.5 

Source : 

Detailed  Annual  Reports  of  the 

1901 

2,196,182 

1,296 

59.0 

Registrar-General    for 

Ireland 

on    Mar- 

1902 

2,193,561 

1,286 

58.6 

riages.  Births  and  Deaths. 

1903 

2,189,440 

1,350 

61.7 

1904 

2,188,276 

1,376 

62.9 

1905 

2,186,577 

1,443 

66.0 
61.6 

1901-1905 

10,954,036 

6,751 

Table  43 

Mortality  from  Cancer  in  Ireland,  Females 

1893-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1893 

2,339,022 

1,228 

52.5 

1906 

2,210,793 

1,915 

86.6 

1894 

2,329,341 

1,309 

56.2 

1907 

2,205,400 

1,808 

82.0 

1895 

2,312,633 

1,301 

56.3 

1908 

2,200,537 

1,787 

81.2 

1909 

2,198,809 

1,871 

85.1 

1896 

2,302,923 

1,337 

58.1 

1910 

2,197,150 

1,952 

88.8 

1897 
.     1898 

2,295,712 

2,288,777 

1,421 
1,419 

61.9 
62.0 

1906-1910 

11,012,689 

9,333 

84.7 

1899 

2,280,436 

1,461 

64.1 

1900 

2,263,580 

1,505 

66.5 

1911 
1912 

2,195,453 
2,195,281 

1,804 
1,966 

82.2 

89.6 

1896-1900 

11,431,428 

7,143 

62.5 

Source : 

Detailed  Annual  Reports  of  the 

1901 

2,250,903 

1,597 

70.9 

Registrar- 

General    for 

Ireland 

on    Mar- 

1902 

2,240,990 

1,575 

70.3 

riages.  Births  and  Deaths. 

1903 

2,228,317 

1,698 

76.2 

1904 

2,219,827 

1,679 

75.6 

1905 

2,212,731 

1,848 

83.5 
75.3 

1901-1905 

11,152,768 

8,397 

619 


APPENDIX  G 

Table  44 

Mortality  from  Cancer  in  Ireland,  by  Provinces  and  Counties 

1901-1910 

Deaths  Rate  per 

County                                                                          Population  from  100,000 

Cancer  Population 

Antrim 1,949,770  1,753  89.9 

Belfast  Coimty  Borough 3,680,630  2,713  73.7 

Down 2,050,960  1,912  93.2 

Armagh 1,228,420  1,332  108.4 

Londonderry 1,425,150  1,382  97.0 

Tyrone 1,466,160  1,326  90.4 

Monaghan 730,330  603  82.6 

Donegal 1,711,290  1,205  70.4 

Fermanagh 636,330  456  71.7 

Cavan 943,570  584  61.9 

Total  for  Ulster 15,822,610  13,266  83.8 

Louth 647,420  598  92.4 

Meath 662,940  573  86.4 

Dublin 1,649,810  1,576  95.5 

Dublin  County  Borough 2,977,200  3,002  100.8 

Kildare 650,970  501  77.0 

Wicklow 607,680  497  81.8 

Carlow 370,000  296  80.0 

Wexford 1,031,880  720  69.8 

Kilkenny 770,610  432  56.1 

Queens 560,230  375  66.9 

Kings 585,090  413  70.6 

Westmeath 608,070  446  73.3 

Longford 452,470  231  51.1 

Total  for  Leinster 11,574,370  9,660  83.5 

Leitrim 664,620  388  58.4 

Sligo 815,640  426  52.2 

Roscommon 978,730  475  48.5 

Mayo 1,956,720  828  42.3 

Galway 1,873,870  953  50.9 

Total  for  Connaught 6,289,580  3,070  48.8. 

Waterford 855,760  645  75.4 

Cork 3,983,580  2,743  68.9 

Tipperary,  S.  R 909,850  680  74.7 

Tipperary,  N.  R 653,480  369  56.5 

Limerick 1,445,830  861  59.6 

Clare 1,082,830  557  51.4 

Kerry 1,627,080  596  36.6 

Total  for  Munster 10,558,410  6,451  61.1 

Total  for  Ireland 44,244,970  32.447  73.3  ■ 

Source:  Supplement  to  the  Forty-seventh  Report  of  the  Registrar-General  of  Mar- 
riages, Births  and  Deaths  in  Ireland  for  the  years  1901-1910. 


620 


APPENDIX  G 

Table  45 

Mortality  from  Cancer  in  Ireland,  by  Organs  and  Parts 

according  to  Sex,  1901-1910 


Organ  or  Part 


Larynx 

Lungs 

Mouth 

Tongue. . .  . 
Pharynx. . . . 
(Esophagus. 
Stomach.  . . 
Intestines.  . 
Rectum. . . . 


Liver  and  gall-bladder 1,682 

Pancreas 

Glands  of  neck 

Kidney  and  bladder 

Prostate 

Male  generative  organs 

Ovary 

Uterus 

Breast 

Arm,  leg 

Jaw 

Face 

Lips 

Other  organs 

Ill-defined 

Not  specified 


MALES 

Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

158 

0.7 

70 

0.3 

156 

0.7 

733 

3.3 

494 

2.3 

456 

2.1 

4,271 

19.5 

878 

4.0 

986 

4.5 

1,682 

7.7 

119 

0.5 

606 

2.8 

255 

1.2 

117 

0.5 

178 

0.8 

65 

0.3 

403 

1.8 

573 

2.6 

588 

2.7 

672 

3.1 

750 

3.4 

372 

1.8 

135 

0.6 

All  organs 14,717 


67.2 


FEIVIALES 

Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

86 

0.4 

76 

0.3 

44 

0.2 

127 

0.6 

144 

0.6 

235 

1.1 

3,771 

17.0 

1,026 

4.6 

744 

3.4 

2,336 

10.5 

137 

0.6 

289 

1.3 

145 

0.7 

260 

1.2 

2,319 

10.5 

2,957 

13.3 

545 

2.5 

204 

0.9 

482 

2.2 

122 

0.6 

833 

3.8 

708 

3.1 

140 

0.6 

17,730 


80.0 


Source:  Supplement  to  the  Forty-seventh  Report  of  the  Registrar-General  of  Mar- 
riages, Births  and  Deaths  in  Ireland,  containing  Decennial  Summaries  for  the  years  1901- 
1910. 


621 


APPENDIX  G 

Table  46 

Mortality  from  Cancer  in  Ireland,  by  Age  and  Sex 

1901-1910 


MALES 

Deaths  Rate  per 

Ages                                                                                           Population  from  100,000 

Cancer  Population 

Under  25 10,992,361  237  2.2 

25-34 3,153,492  328  10.4 

35-44 2,525,420  1,014  40.2 

45-54 1,956,435  2,519  128.8 

55-64 1,529,695  4,269  279.1 

65-74 1,197,058  4,357  364.0 

75  and  over 529,594  1,993  376.3 

All  ages 21,884,055  14,717  67.2 

FE3*L\LES 

Under  25 10,761,329  205  1.9 

25-34 3,280,488  566  17.3 

35-44 : 2,549,028  1,939  76.1 

45-54 2,063,604  3,868  187.4 

55-64 1,624,728  5,177  318.6 

65-74 1,316,628  4,137  314.2 

75  and  over 569,652  1,838  322.7 

All  ages 22,165,457  17,730  80.0 

Source:  Supplement  to  the  Forty-seventh  Report  of  the  Registrar-General  of  Mar- 
riages, Births  and  Deaths  in  Ireland,  containing  Decennial  Summaries  for  the  years 
1901-1910. 


622 


APPENDIX  G 

Table  47 

Mortality  from  Cancer  in  Ireland,  by  Organs  and  Parts 

and  Duration  of  Illness,  Males 

1901 

Number  of  Deaths  by  Duration  op  Illness 

6  Mos.       6  Mos.      1  Year       2  Years  Over  Total  Cases  Duration 

and              to                to                 to  3  of  Known         Not               Grand 

Organ  or  Part                Under       1  Year      2  Years       3  Years  Years  Duration        Given             Total 

Face  and  nose 10           12           19            5  12  58             9               67 

Jaw 9           24            7            2  1  43             5               48 

Lips 3           17           20            9  9  58             5               63 

Tongue 11           24            8            2  . .  45             3               48 

Pharynx  and  throat .  .     13           15            8           . .  2  38             6               44 

(Esophagus 9           18             1           ..  ..  28              1                29 

Stomach 136         120           64            4  3  327           63             390 

Rectum 14           28           28            4  2  76            13               89 

Other  intestines 19           14           11             1  2  47           21                68 

Liver  and  gall-bladder    72          37           16            4  1  130           25              155 

Glands  of  the  neck....     15           29            3            2  .  .  49            12               61 
Other  or  not  specified 

organs 58           63          44           12  8  185           49              234 

All  organs 369        401         229           45  40  1,084          212           1,296 

Percentage  op  Distribution  of  Cases  with  Known  Duration 

Face  and  nose 17.2       20.7       32.8         8.6  20.7  100.0 

Jaw 20.9        55.8        16.3          4.7  2.3  100.0 

Lips 5.2        29.3        34.5        15.5  15.5  100.0 

Tongue 24.5       53.3        17.8         4.4  . .  100.0 

Pharynx  and  throat ..  34.2       39.5        21.0           ..  5.3  100.0 

(Esophagus 32.1        64.3         3.6           ..  ..  100.0 

Stomach 41.6       36.7        19.6          1.2  0.9  100.0 

Rectum 18.4       36.8       36.8         5.3  2.7  100.0 

Other  intestines 40.4       29.8       23.4         2.1  4.3  100.0 

Liver  and  gall-bladder  55.4        28.4        12.3          3.1  0.8  100.0 

Glands  of  the  neck....  30.6       59.2         6.1          4.1  ..  100.0 
Other  or  not  specified 

organs 31.3       34.1        23.8         6.5  4.3  100.0 

All  organs 34.0       37.0        21.1         4.2  3.7  100.0 

Source:     Supplement  to  the  Thirty-eighth  Detailed  Annual  R<eport  of  the  Registrar- 
General  of  Marriages,  Births  and  Deaths  in  Ireland. 


623 
41 


APPENDIX  G 

Table  48 
Mortality  from  Cancer  in  Ireland,  by  Organs  and  Parts 
and  Duration  of  Illness,  Females 
1901 


Ndmbeb  of  Deaths  bt  Duration  op  Illness 

6  Mos.  6  Mos.  1  Year  2  Years       Over  Total  Cases    Duration 

and  to  to  to                3  of  Known         Not              Grand 

Organ  or  Part                  Under  1  Year  2  Years  3  Years      Years  Duration        Given               Total 

Face  and  nose 4  10  8  8             9  39            11                50 

Jaw 7  4  2  11  15              3                18 

Lips 2  2  4  11  10             1                11 

Tongue 3  4  2  ..            ..  9              2                11 

Phari-nx  and  throat..        3  6  9  3                12 

(Esophagus 6  5  2  . .  13             2               15 

Stomach 123  109  67  11             5  315            48              363 

Eectum 7  18  19  2            1  47             4               51 

Other  intestines 16  25  7  3            ..  51            17                68 

Liver  and  gall-bladder     90  52  19  .  .             1  162           29              191 

Glands  of  the  neck...     10  2  4  1           .  .  17             3               20 

Breast 26  75  87  25           18  231            34              265 

Uterus 38  87  49  7             6  187            50              237 

Other  or  not  specified 

organs 7i  73  50  14           14  223            62              285 

All  organs 407  472  320  73           56  1,328          269           1,597 

Pehcentage  of  Disteibution  of  Cases  with  Known  Duration 

Face  and  nose 10.3  25.6  20.5  20.5        23.1  100.0 

Jaw 46.6  26.7  13.3  6.7          6.7  100.0 

Lips 20.0  20.0  40.0  10.0        10.0  100.0 

Tongue 33.3  44.5  22.2  . .            . .  100.0 

Pharj-nx  and  throat.  .  33.3  66.7  100.0 

(Esophagus 46.1  38.5  15.4  ..            ..  100.0 

Stomach 39.0  34.6  21.3  3.5          1.6  100.0 

Rectum 14.9  38.3  40.4  4.3          2.1  100.0 

Other  intestines 31.4  49.0  13.7  5.9            ..  100.0 

Liver  and  gall-bladder  55.6  32.1  11.7  ..          0.6  100.0 

Glands  of  the  neck....  58.8  11.8  23.5  5.9            ..  100.0 

Breast 11.2  32.5  37.7  10.8          7.8  100.0 

Uterus 20.3  46.5  26.2  3.8          3.2  100.0 

Other  or  not  specified 

organs '32.3  32.7  22.4  6.3         6.3  100.0 

All  organs 30.7  35.5  24.1  5.5         4.2  100.0 

Source:  Supplement  to  the  Thirty-eighth  Detailed  Annual  Report  of  the  Registrar- 
General  of  Marriages,  Births  and  Deaths  in  Ireland. 


624 


APPENDIX  G 

Table  49 

Mortality  from  Cancer  in  Dublin 

1901-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1901 

290,638 

237 

81.5 

1906 

297,718 

306 

102.8 

1902 

292,054 

251 

85.9 

1907 

299,134 

297 

99.3 

1903 

293,470 

295 

100.5 

1908 

300,550 

314 

104.5 

1904 

294,886 

280 

95.0 

1909 

301,966 

314 

104.0 

1905 

296,302 

273 

92.1 
91.0 

1910 
1906-1910 

303,382 

369 

121.6 

1901-1905 

1.467,350 

1,336 

1,502,750 

1,600 

106.5 

1911 

304,802 

348 

114.2 

1912 

306,218 

356 

116.3 

Source: 

Detailed  Annual  Reports  of  the 

Registrar- 

General    for 

Ireland 

on    Mar- 

riages.  Births  and  Deaths. 

1906,  Report  on    th 

e  State 

of  Public 

Health  in 

the  City  of  DubHn. 

Table  50 

Mortality  from  Cancer  in  Belfast 

1901-1912 


Year 

Population 

Deaths 

from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1901 
1902 
1903 
1904 
1905 

349,180 
352,956 
356,732 
360,509 
364,285 

224 
218 
239 
245 
282 

64.2 
61.8 
67.0 
68.0 

77.4 

67.7 

1906 
1907 
1908 
1909 
1910 

1906-1910 

368,062 
371,838 
375,615 
379,391 
383,168 

261 
278 
304 
332 
330 

70.9 
74.8 
80.9 
87.5 
86.1 

1901-1905 

1,783,662 

1,208 

1,878,074 

1,505 

80.1 

1911 
1912 

386,947 
390,724 

315 
331 

81.4 
84.7 

Source :     Detailed  Annual  Reports  of  the 
Registrar- General   for   Ireland    on    Mar- 
riages, Births  and  Deaths. 

625 


APPENDIX  G 

Table  51 

Mortality  from  Cancer  in  the  Isle  of  Man 

1902-1913 


Year 

Population 

Deaths 

from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 

from 

Cancer 

Rate  per 

100,000 

Population 

1902 
1903 
1904 
1905 

54,481 
54,210 
53,938 
53,666 

60 
62 

58 

72 

110.1 
114.4 
107.5 
134.2 

1906 
1907 
1908 
1909 
1910 

53,394 
53,122 

52,850 
52,578 
52,306 

65 
59 

68 
68 
70 

121.7 
111.1 

128.7 
129.3 
133.8 

1902-1905 

216,295 

252 

116.5 

1906-1910 

264,250 

330 

124.9 

1911 
1912 
1913 

52,034 
51,762 
51,490 

80 
53 

87 

153.7 
102.4 
169.0 

Source :  Annual  Reports  of  the  Registrar- 
General  on  Births,  Deaths,  Marriages  and 
Vaccinations  in  the  Isle  of  Man. 

Table  52 

Mortality  from  Cancer  in  the  Isle  of  Man,  Males 

1902-1913 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1902 
1903 
1904 
1905 

25,345 
25,191 
25,038 
24,885 

24 
33 

27 
28 

94.7 
131.0 
107.8 
112.5 

111.5 

1906 
1907 
1908 
1909 
1910 

1906-1910 

24,732 
24,580 

24,422 
24,265 
24,108 

33 
25 
31 
31 
39 

133.4 
101.7 
126.8 
127.8 
161.8 

1902-1905 

100,459 

112 

122,107 

159 

130.2 

1911 
1912 
1913 

23,951 
23,811 
23,671 

32 
21 
36 

133.6 

88.2 
152.1 

Source :  Annual  Reports  of  the  Registrar- 
General  on  Births,  Deaths,  Marriages  and 
Vaccinations  in  the  Isle  of  Man. 

626 


APPENDIX  G 

Table  53 

Mortality  from  Cancer  in  the  Isle  of  Man,  Females 

1902-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1902 

29,136 

36 

123.6 

1906 

28,662 

32 

111.6 

1903 

29,019 

29 

99.9 

1907 

28,542 

34 

119.1 

1904 

28,900 

31 

107.3 

1908 

28,428 

37 

130.2 

1905 

28,781 

44 

152.9 

1909 
1910 

28,313 
28,198 

37 
31 

130.7 
109.9 

1902-1905 

115,836 

140 

120.9 

1906-1910 

142.143 

171 

120.3 

1911 

28,083 

48 

170.9 

1912 

27,951 

32 

114.5 

1913 

27,819 

51 

183.3 

Source: 

Annual  Reports  of  the  Registrar- 

General  on  Births,  Deaths,  Marriages  and 

Vaccinations  in  the  Isle  of  Man. 

Table  54 

Mortality  from  Cancer  in  Guernsey,  Channel  Islands 

1900-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1900 

40,200 

34 

84.6 

1906 

40,990 

48 

117.1 

1907 

41,174 

58 

140.9 

1901 

40,300 

34 

84.4 

1908 

41,350 

46 

111.2 

1902 

40,475 

40 

98.8 

1909 

41,524 

35 

84.3 

1903 

40,650 

40 

98.4 

1910 

41,670 

47 

112.8 

1904 

40,795 

39 

95.6 

1905 

40,884 

47 

115.0 
98.5 

1906-1910 
1911 

206,708 
41,854 

234 
53 

113.2 

1901-1905 

203,104 

200 

126.6 

1912 

41,900 

44 

105.0 

1913 

42,000 

48 

114.3 

Source : 

Guernsey, 

Fifteenth 

Annual 

Report  of  the  Medical  Officer  of  Health  for 

the  year  1913. 

627 


APPENDIX  G 

Table  55 

Mortality  from  Cancer  in  Gibraltar* 

1900-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1900 

20,230 

21 

103.8 

1906 

19,971 

13 

65.1 

1907 

19,894 

7 

35.2 

1901 

20,355 

18 

88.4 

1908 

19,817 

13 

65.6 

1902 

20,279 

16 

78.9 

1909 

19,740 

13 

65.9 

1903 

20,202 

5 

24.8 

1910 

19,663 

21 

106.8 

1904 

20,125 

12 

59.6 

1905 

20,048 

14 

69.8 
64.4 

1906-1910 
1911 

99,085 
19,586 

67 
16 

67.6 

1901-1905 

101,009 

65 

81.7 

1912 

19,017 

18 

94.7 

1913 

18,448 

19 

103.0 

Source: 

Annual  Reports  of  the  Public 

Health  of  Gibraltar. 

*  The  civil 

population  only. 

Table  56 

Mortality  from  Cancer  in  Malta  and  Gozo 

1896-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1896 

175,486 

76 

43.3 

1906 

199,784 

94 

47.1 

1897 

176,976 

87 

49.2 

1907 

202,649 

110 

54.3 

1898 

178,466 

78 

43.7 

1908 

205,514 

96 

46.7 

1899 

179,956 

86 

47.8 

1909 

208,379 

102 

48.9 

1900 

182,594 

88 

48.2 
46.4 

1910 
1906-1910 

211,244 

98 

46.4 

1896-1900 

893,478 

415 

1,027,570 

500 

48.7 

1901 

185,459 

98 

52.8 

1911 

214,112 

107 

50.0 

1902 

188,324 

87 

46.2 

1912 

216,947 

109 

50.2 

1903 

191,189 

89 

46.6 

1904 

194,054 

107 

55.1 

Source: 

Malta,  Annual  Reports  on  the 

1905 

196,919 

76 

38.6 

47.8 

Public  Health  Department. 

1901-1905 

955,945 

457 

APPENDIX  G 

Table  57 

Mortality  from  Cancer  in  Malta  and  Gozo,  by  Organs  and  Parts 

according  to  Sex,  1911-1913 


Organ  or  Part 

Buccal  cavity , 

Stomach  and  iiver 

Peritoneum,  intestines  and  rectum  , 

Breast , 

Female  generative  organs 

Skin 

Other  or  not  specified  organs 


MA 

LES 

FEMALES 

Deaths 

Rate  per 

Deaths 

Rate  per 

from 

100,000 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

8 

3.7 

0.0 

33 

15.3 

24 

11.1 

6 

2.8 

10 

4.6 

23 

10.6 

30 

13.9 

io 

4.7 

3 

1.4 

41 

19.1 

23 

10.7 

All  organs . 


98 


45.6 


113 


52.3 


Source:     Malta,  Reports  on  the  Public  Health  Department,  1911-1912  and  1912-1913. 
Note:  Two  fiscal  years,  ending  March  31,  1913. 


Table  58 

Mortality  from  Cancer  in  Norway 

1881-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881-1885 

9,566,500 

4,725 

49.4 

1901 

2,235,000 

2,126 

95.1 

1902 

2,254,600 

2,064 

91.5 

1886 

1,943,900 

984 

50.6 

1903 

2,265,900 

2,112 

93.2 

1887 

1,955,200 

1,094 

56.0 

1904 

2,274,500 

2,182 

95.9 

1888 

1,961,800 

1,091 

55.6 

1905 

2,284,400 

2,248 

98.4 

1889 

1,969,200 
l,981,60a 

1,116 
1,131 

56.7 
57.1 

55.2 

1890 

1901-1905 
1906 

11,314,400 
2,293,800 

10,732 
2,239 

94.9 

1886-1890 

9,811,700 

5,416 

97.6 

1907 

2,302,700 

2,310 

100.3 

1891 

1,996,900 

1,224 

61.3 

1908 

2,318,400 

2,252 

97.1 

1892 

2,010,000 

1,278 

63.6 

1909 

2,338,400 

2,226 

95.2 

1893 

2,021,400 

1,405 

69.5 

1910 

2,353,300 

2,186 

92.9 

1894 

2,039,800 
2,065,900 

1,449 
1,464 

71.0 
70.9 

67.3 

1895 

1906-1910 
1911 

11,606,600 
2,370,700 

11,213 

2,292 

96.6 

1891-1895 

10,134,000 

6,820 

96.7 

1912 

2,393,300 

2,505 

104.8 

1896 

2,094,100 

1,691* 

80.8 

1897 

2,123,700 

1,802 

84.9 

Source: 

Norges 

ofBcielle 

Statistik: 

1898 

2,155,400 

l,802t 

83.6    ■ 

Sundhedstilstanden  og  Medicinalforholdene. 

1899 

2,185,300 

1,931 

88.4 

Statistisk 

Aarsbok  for  Xongeriket  Norge. 

1900 

2,211,300 

2,008 

90.8 

*Two  cases  sex  unknown,      t  One 

case  sex  un- 

known 

1896-1900 

10,769,800 

9,234 

85.7 

629 


APPENDIX  G 

Table  59 

Mortality  from  Cancer  in  Norway,  Males 

1896-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1896 

1,014,374 

835 

82.3 

1906 

1,110,458 

1,106 

99.6 

1897 

1,029,302 

901 

87.5 

1907 

1,114,233 

1,088 

97.6 

1898 

1,045,266 

931 

89.1 

1908 

1,121,292 

1,095 

97.7 

1899 

1,060,373 

954 

90.0 

1909 

1,130,422 

1,039 

91.9 

1900 

1,073,604 

989 

92.1 
88.3 

1910 
1906-1910 

1,1.37,079 

1,069 

94.0 

1896-1900 

5,222,919 

4,610 

5,613,484 

5,397 

96.1 

1901 

1,084,590 

1,062 

97.9 

1911 

1,144,937 

1,164 

101.7 

1902 

1,093,576 

1,026 

93.8 

1912 

1,155,057 

1,265 

109.7 

1903 

1,098,529 

1,048 

95.4 

1904 

1,102,170 

1,091 

99.0 

Source: 

Norges 

officielle 

Statistik: 

1905 

1,106,438 

1,087 

98.2 

Sundhedstilstanden  og  Medicinalf orholdene . 

Statistisk  Aarsbok  for  Kongerik 

1901-1905 

5,485,303 

5,314 

96.9 

Table  60 

Mortality  from  Cancer  in  Norway,  Females 

1896-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1896 

1,079,726 

854 

79.1 

1906 

1,183,342 

1,133 

95.7 

1897 

1,094,398 

901 

82.3 

1907 

1,188,467 

1,222 

102.8 

1898 

1,110,134 

870 

78.4 

1908 

1,197,108 

1,157 

96.6 

1899 

1,124,927 

977 

86.9 

1909 

1,207,978 

1,187 

98.3 

1900 

1,137,696 

1,019 

89.6 
83.3 

1910 
1906-1910 

1,216,221 

1,117 

91.8 

1896-1900 

5,546,881 

4,621 

5,993,116 

5,816 

97.0 

1901 

1,150,410 

1,064 

92.5 

1911 

1,225,763 

1,128 

92.0 

1902 

1,161,024 

1,038 

89.4 

1912 

1,238,243 

1,240 

100.3 

1903 

1,167,371 

1,064 

91.1 

1904 

1,172,330 

1,091 

93.1 

Source: 

Norges 

officielle 

Statistik: 

1905 

1,177,962 

1,161 

98.6 

Sundhedstilstanden  og  Medicinalf  orholdene. 

Statistisk 

Aarsbok  for 

Kongeriket  Norge. 

1901-1905 

5,829,097 

5,418 

92.9 

630 


APPENDIX  G 

Table  61 

Mortality  from  Cancer  in  Norway,  by  Organs  and  Parts 

according  to  Sex,  1896-1910 


MALES 


Deaths 
Organ  or  Part  from 

Cancer 

Stomach 9,847 

Liver 999 

Breast 9 

Generative  organs 181 

Other  organs 2,925 

Not  specified 473 

Sarcoma 887 

All  organs 15,321 


93.9 


s 

FEMALES 

Rate  per 

Deaths 

Rate  per 

100,000 

from 

100,000 

Population 

Cancer 

Population 

60.3 

8,033 

46.2 

6.1 

922 

5.3 

0.1 

1,156 

6.7 

1.1 

1,833 

10.5 

17.9 

2,651 

15.3 

2.9 

480 

2.8 

5.5 

780 

4.5 

15,855 


91.3 


Table  62 

Mortality  from  Cancer  in  Norway 

Relative  Mortality  of  Females,  by  Organs  and  Parts,  1896-1910 


Organ  or  Part 

Rate  per  100,000  Popuiatiox 
Males                Females 

Relative  Mortality 
of  Females 

Breast 

Generative  organs 

Not  specified .                  

0.06 

1.11 

2.90 

6.66 
10.55 

2.76 

5.31 
15.26 

4.49 
46.25 

11,100 

950 

95 

Liver 

Other  organs 

Sarcoma 

Stomach 

6.12 

17.92 

5.43 

60.33 

87 
85 
83 

77 

All  organs 

93.87 

91.28 

97 

Note:     In  this  table  the  mortality  of  males  from  cancer  of  any  organ  or  part  is  taken  as 
100  and  the  corresponding  mortality  of  females  is  given  accordingly. 

Table  63 

Mortality  from  Cancer  in  Norway,  by  Age  and  Sex 

1896-1910 


MALES 

FEMALES 

Deaths 

Rate  per 

Deaths 

Rate  per 

Age  Groups 

Population 

from 

100,000 

Age  Groups 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

Under  10 

4,195,228 

102 

2.4 

Under  10 

4,029,369 

55 

1.4 

10-19 

3,507,441 

71 

2.0 

10-19 

3,406,113 

67 

2.0 

20-29 

2,399,349 

136 

5.7 

20-29 

2,672,077 

154 

5.8 

30-39 

1,784,657 

365 

20.5 

30-39 

2,134,539 

630 

29.5 

40-49 

1,536,051 

1,296 

84.4 

40-49 

1,773,387 

1,938 

109.3 

50-59 

1,191,531 

3,147 

264.1 

50-59 

1,355,950 

3,379 

249.2 

60-69 

929,889 

4,783 

514.4 

60-69 

1,058,502 

4,337 

409.7 

70-79 

604,601 

4,287 

709.1 

70-79 

710,312 

3,956 

556.9 

80-89 

161,850 

1,064 

657.4 

80-89 

209,724 

1,251 

596.5 

90  and  over       11,109 

53 

477.1 

90  and  over       19,121 

71 

371.3 

Age  imknown 

17 

93.9 

Age  unknc 
All  ages 

3wn 

17 

All  ages 

16,321,706 

15,321 

17,369,094 

15,855 

91.3 

Source: 

Norges  officielle  Statistik :  Sund- 

hedstilstanden  og  Medicinalforholdene. 

631 


APPENDIX  G 

Table  64 

Mortality  from  Cancer  in  Norway,  by  Organs  and  Parts 

according  to  Age,  Males 

1896-1910 

AGE  GROUPS 

'  80  and 

Organ  or  Part                   Under  30      30-39           40-49         50-59  60-69  70-79              Over 

Deaths  fkom  Canceh 

Stomach 40           206           872        2,184  3,229  2,747             562 

Liver 3             15            83           191  342  286              79 

Breast ..              ..                2  3  3                 1 

Generative  organs 1               6             10             24  45  65               30 

Otherorgans 40             55           201           524  823  920             352 

Notspecified 8             11             32             98  158  130               36 

Sarcoma 217            72            98           124  183  136              57 

Rate  peb  100,000  Population 

Stomach 0.40        11.54        56.77      183.29  347.25  454.35        324.93 

Liver 0.03          0.84          5.40        16.03  36.78  47.30          45.68 

Breast ..              ..          0.17  0.32  0.50           0.58 

Generative  organs 0.01          0.34          0.65          2.01  4.84  10.75          17.35 

Otherorgans 0.40          3.08        13.09        43.98  88.51  152.17        203.52 

Notspecified 0.08          0.62          2.08          8.22  16.99  21.50          20.81 

Sarcoma 2.15         4.03         6.38        10.41  19.68  22.49         32.96 

Source:    Norges  officielle  Statistik:  Sundhedstilstanden  og  MedicinaKorholdene. 

Table  65 

Mortality  from  Cancer  in  Norway,  by  Organs  and  Parts 

according  to  Age,  Females 

1896-1910 

AGE  GROUPS 

80  and 

Organ  or  Part                     Under  30       30-39           40-49           50-59  60-69  70-79               Over 

Deaths  from  Cancer 

Stomach 37           220          780        1,677  2,429  2,257            627 

Liver 6             23            96           202  254  245              94 

Breast 8             77           247           292  268  180               83 

Generative  organs 28           144           409           490  405  263               91 

Otherorgans 25             86           253           494  708  745             335 

Notspecified 7             20            55            97  137  124              40 

Sarcoma 165             60            98           127  136  142              52 

Rate  per  100,000  Population 

Stomach 0.37        10.31        43.98      123.68  229.48  317.75        273.98 

Liver 0.06          1.08          5.41        14.90  24.00  34.49          41.08 

Breast 0.08          3.61        13.93        21.53  25.32  25.34          36.27 

Generative  organs 0.28          6.75        23.06        36.14  38.26  37.03          39.76 

Otherorgans 0.25          4.03        14.27        36.43  66.89  104.88        146.39 

Notspecified 0.07          0.94          3.10          7.15  12.94  17.46          17.48 

Sarcoma    1.63          2.81          5.53          9.37  12.85  19.99          22.72 

Source:     Norges  ofBcielle  Statistik:   Sundhedstilstanden  og  MedicinaKorholdene. 


APPENDIX  G 

Table  66 

Proportionate  Mortality  from  Cancer  in  Norway,  for  Whole  Country 

and  for  Cities,  by  Organs  and  Parts,  according  to  Sex 

1896-1901 


Organ  or  Part 

Stomach 

Liver 

Breast 

Generative  organs . 
Other  organs 


PERCENTAGE 

Whole  Country 

Males 

Females 

Total 

66.9 

52.9 

60.0 

7.6 

6.0 

6.8 

0.1 

7.4 

3.8 

1.0 

11.6 

6.3 

24.4 

22.1 

23.1 

All  organs 100.0 

Source:     Dr.  Munch  Soegaard: 
fiir  Krebsforschung,  1913. 


Cities 

Males 

Females 

Total 

64.0 

45.6 

54.0 

9.0 

7.0 

8.0 

7.6 

4.2 

1.2 

16.2 

9.5 

25.8 

23.6 

24.3 

100.0        100.0  100.0         100.0  100.0 

Die  Krebs  Formationen  Norwegens.     In:  Zeitschrift 


Table  67 

Proportionate  Mortality  from  Cancer  in  Norway,  by  Organs  afid  Parts 

and  Geographical  Divisions  of  Kingdom 

1896-1907 


PERCENTAGE 

Male  Gen.    Female 
Stomach  Liver  Breast  Organs   Gen.  Organs 

Southern  Norway...  60.8  7.2  3.8  0.6  5.3 

Interior  Norway 62.4  7.0  3.7  0.7  5.0 

Western  Norway 62.3  5.5  3.8  0.6  5.9 

Northern  Norway...  68.6  5.2  3.2  0.6  4.8 

Total 62.7  6.4  3.7  0.6  5.3 

Cities  alone 52.5  8.0  4.7  10.5 

Rural  alone 67.6  5.6  3.2  3.7 

Source:     Dr.  Munch  Soegaard:     Die  Krebs  Formationen  Norwegens. 
fiir  Krebsforschung,  1913. 


Other 
Organs 

17.5 
16.6 

18.4 
14.8 

17.2 


Not 
Specified 

4.8 
4.6 
3.5 

2.8 

4.1 


24.3 
19.9 

In:  Zeitschrift 


Table  68 

Mortality  from  Cancer  in  Kristiania 

1896-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1896 

192,174 

182 

94.7 

1906 

235,441 

233 

99.0 

1897 

199,616 

186 

93.2 

1907 

236,862 

282 

119.1 

1898 

207,058 

151 

72.9 

1908 

238,283 

240 

100.7 

1899 

215,481 

155 

71.9 

1909 

239,704 

239 

99.7 

1900 

223,577 

185 

82.7 
82.8 

1910 
1906-1910 

241,125 

226 

93.7 

1896-1900 

1,037,906 

859 

1,191,415 

1,220 

102.4 

1901 

228,336 

222 

97.2 

1911 

242,546 

249 

102.7 

1902 

229,757 

204 

88.8 

1912 

243,967 

275 

112.7 

1903 

231,178 

189 

81.8 

1904 

232,599 

247 

106.2 

Source. 

Norges  oflBcielle  Statistik:  1896- 

1905 

234,020 

240 

102.6 

1912.     Sundhedstilstanden  og 

Medicinal- 

forholdene. 

1901-1905 

1,155,890 

1,102 

95.3 

633 


APPENDIX  G 


Table  69 

Table  71 

Mortality  from  Cancer  in 

Bergen 

Mortality  from  Cancer  in  the  Cities 

1896- 

1912 

Rate  per 

o 

f  Sweden, 

1901-1912 

Deaths 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1896 

63,895 

64 

100.2 

1901 

1,112,883 

1,122 

100.8 

1897 

65,752 

60 

91.3 

1902 

1,129,913 

1,141 

101.0 

1898 

67,609 

69 

102.1 

1903 

1,151,616 

1,216 

105.6 

1899 

69,466 

67 

96.5 

1904 

1,175,625 

1,169 

99.4 

1900 

71,323 

64 

89.7 
95.8 

1905 
1901-1905 

1,202,638 

1,250 

103.9 

1896-1900 

338,045 

324 

5,772,675 

5,898 

102.2 

1901 

72,482 

70 

96.6 

1906 

1,243,496 

1,221 

98.2 

1902 

72,944 

76 

104.2 

1907 

1,285,837 

1,378 

107.2 

1903 

73,406 

75 

102.2 

1908 

1,313,513 

1,370 

104.3 

1904 

73,868 

81 

109.7 

1909 

1,328,798 

1,426 

107.3 

1905 

74,330 

72 

96.9 
101.9 

1910 
1906-1910 

1,354,850 

1,422 

105.0 

1901-1905 

\  ■ 

367,030 

374 

6,526,494 

6,817 

104.5 

1906 

74,792 

84 

112.3 

1911 

1,402,583 

1,446 

103.1 

1907 

75,254 

91 

120.9 

1912 

1,422,903 

1,436 

100.9 

1908 

75,716 

68 

89.8 

1909 

76,178 

84 

110.3 

Source: 

Statistisk  Arsbok  for  Sverige, 

1910 

76,640 

65 

84.8 
103.5 

1914. 

Table  72 

1906-1910 

378,580 

392 

Mortality   from  Cancer  in 

Sweden 

1911 

77,102 

75 

97.2 

Cities  and  Rural, 

according  to  Sex 

1912 

77,464              84          108.4 
Norges  officielle  Statistik:  1896- 

1911 

Source : 

1912.     Sundhedstilstanden  og 

Medicinal- 

Population 

Deaths 
from 

Rate  per 
100,000 

forholdene 

Cities 
Males 

647,624 

Cancer 
589 

Population 

90.9 

Table  70 

Females  . . 

754,959 

857 

113.5 

Mortality  irom  uancer  m  tne  ijity  ot 

Hammerfest 

Total... 

1,402,583 

1,446 

103.1 

1896- 

1911 

Rate  per 

RUKAL 

Males 

2,069,457 

2,030 

Deaths 

98.1 

Year 

Population 

from 
Cancer 

100,000 
Population 

94.8 

Females. . . 

2,089,759 

1,994 

95.4 

1896-1900 

11,605 

11 

Total.  .  . 

4,159,216 

4,024 

96.7 

1901-1905 

12,535 

17 

135.6 

1906-1910 

1.3,638 

18 

132.0 

Whole  Country 

1911 

2,862 

4 

139.8 

Males 

2,717,081 

2,619 

96.4 

Females. . . 

2,844,718 

2,851 

100.2 

Source: 

Norees  officielle  Statistik:  1896- 

1911.     Sundh^tilstanden   og 
forholdene. 

Medicinal- 

Total. . . 

5,561,799 

5,470 

98.3 

Note:     Hammerfest 

is  the  nothemmost 

Source: 

Sveriges 

officiella 

Statistik: 

city  of  the 

world,  70° 

40'  North  Latitude. 

Dbdsfallsstatistik,  1911. 

634 


APPENDIX  G 

Table  73 

Cancer  Census  of  Sweden,  by  Provinces  and  Sex 

1905 


Province 

Malmohus 

Kristianstad 

Blekinge 

Halland 

Kronoberg 

Jbnkoping 

Elfsborg 

Gbteborg  and  Bohus . 

Kalmar 

Gottland 

Southern  Sweden . . . . 

Ostergotland 

Skaraborg 

Sbdermanland 

Orebro 

Stockholm  (city) 

Stockholm  (rural) . . , 

Upsala 

Vestmanland 

Vermland 

South  Central , 

Gefleborg 

Kopparberg , 

Jemtland 

Vester-Norrland , 

North  Central 

Vesterbotten 

Norrbotten 

Northen  Sweden.. . . 

Total  for  Sweden . . . 

Cities  alone 

Rural  districts 


Source:     Zeitschrift  fiir  Krebsforschung,  7.  Band. 


Cases  of  Canceb 

Total 

Males 

Femal 

126 

51 

75 

55 

24 

31 

52 

23 

29 

33 

11 

22 

40 

20 

20 

48 

17 

31 

69 

25 

'44 

180 

77 

103 

44 

18 

26 

23 

8 

15 

670 

274 

396 

91 

32 

59 

42 

23 

19 

57 

23 

34 

60 

22 

38 

239 

68 

171 

77 

28 

49 

42 

18 

24 

52 

21 

31 

90 

36 

54 

750 

271 

479 

66 

24 

42 

80 

35 

45 

35 

13 

22 

84 

35 

49 

265 

107 

158 

31 

16 

15 

38 

23 

15 

69 

39 

30 

1,754 

691 

1,063 

689 

217 

472 

1,065 

474 

591 

Rate  per  100,000  Population 


Total 

Males 

Females 

29.2 

24.3 

33.9 

25.0 

22.4 

27.5 

35.0 

31.1 

38.8 

23.0 

15.9 

29.7 

25.4 

25.8 

25.0 

23.3 

16.9 

29.3 

24.6 

18.5 

30.3 

50.4 

44.9 

55.5 

19.4 

16.2 

22.4 

43.1 

31.9 

53.8 

29.9 

25.1 

34.3 

31.7 

23.0 

39.8 

17.6 

19.8 

15.4 

33.6 

27.4 

39.7 

30.0 

22.3 

37.4 

73.7 

46.2 

96.5 

40.0 

29.4 

50.5 

33.4 

29.6 

37.0 

34.9 

28.5 

41.1 

35.3 

29.0 

41.2 

38.3 

28.6 

47.3 

26.8 

19.7 

33.8 

35.7 

31.4 

40.0 

30.9 

22.5 

39.7 

34.9 

29.2 

40.5 

32.0 

25.9 

38.1 

20.3 

20.8 

19.8 

25.3 

31.2 

20.4 

23.0 

25.6 

20.3 

33.1 

26.7 

39.2 

56.7 

38.7 

72.0 

26.1 

23.4 

28.8 

635 


APPENDIX  G 

Table  74 

Cancer  Census  of  Sweden,  by  Organs  and  Parts 

Urban  and  Rural,  1905,  Males 


Cases 

OF  Cancer 

Percentage  op  All  Cases 

Organ  or  Part 

Cities 

Rural  Districts 

Cities 

Rural  Districts 

Lips 

Tongue 

Mouth 

2 

8 

1 

48 
6 

4 

0.9 
3.7 
0.5 

10.1 
1.3 
0.8 

Jaw 

3 

5 

1.4 

1.1 

Pharynx 

Larynx 

Thyroid  gland 

Lungs 

Breast 

1 

1 

.......              3 

2 

2 

i 

3 

0.5 
0.5 

1.4 
0.9 

0.4 

0.2 
0.6 

(Esophagus 

Stomach 

20 

108 

12 

294 

9.2 
49.8 

2.5 
62.0 

Intestines 

29 

37 

7 
3 

13.4 
1.8 
3.2 

7.8 

Liver 

4 

1.5 

Pancreas 

7 

0.6 

Peritoneum 

2 

0.4 

4 

8 
6 

1.8 
0.9 

1.7 

Prostate 

2 

1.3 

Penis 

4 

8 

1.8 

1.7 

Cancer  cutis 

18 

28 

474 

8.3 

6.0 

217 

All  organs 

100.0 

100.0 

Source:     Zeitschrift  fur  Krebsforschung,  7.  Band. 


Table  75 

Cancer  Census  of  Sweden,  by  Organs  and  Parts 

Urban  and  Rural,  1905,  Females 


Organ  or  Part 


Lips 

Tongue 

Mouth 

Jaw 

Pharynx 

Larynx 

Thyroid  gland 

Limgs 

Breast 

(Esophagus 

Stomach 

Intestines 

Liver 

Pancreas 

Peritoneum 

Kidney  and  bladder . 

Uterus 

Ovaries 

Vagina 

Cancer  cutis 


Cases  of  Cancer         Percentage  op  All  Cases 


Cities 
2 
1 
2 
8 
1 


123 

11 

129 

39 

4 

2 

5 

5 

85 

22 

7 

22 


Rural  Districts 


11 

0.4 

9 

0.2 

3 

0.4 

6 

1.7 

2 

0.2 

0.0 

0.4 

i 

0.4 

131 

26.1 

11 

2.3 

216 

27.3 

50 

8.3 

5 

0.8 

2 

0.4 

2 

1.1 

4 

1.1 

78 

18.0 

28 

4.7 

8 

1.5 

24 

4.7 

All  organs 472  591 

Source:     Zeitschrift  fiir  Krebsforschung,  7.  Band. 


Cities  Rural  Districts 
1.9 
1.5 
0.5 
1.0 
0.3 
0.0 
.  0.0 
0.2 

22.2 
1.9 

36.5 
8.5 
0.8 
0.3 
0.3 
0.7 

13.2 
4.7 
1.4 
4.1 


100.0 


100.0 


636 


APPENDIX  G 


Table  76 

Table  77 

Mortality  from  Cancer 

Mortality  from  Cancer 

Stockholm 

Goteborg 

1908- 

1913 

Rate  per 

1908-19 

13 

Deaths 

Year 

Population 

from 

100,000 

Deaths 

Rate  per 

Cancer 

Population 

Year 

Population 

from 

100,000 

1908 

338,521 

433 

127.9 

Cancer 

Population 

•  1909 

340,689 

426 

125.0 

1908 

161,502 

142 

87.9 

1910 

342,074 

423 

123.7 

1909 

163,218 

161 

98.6 

1911 

344,461 

349 

101.3 

1910 

165,883 

145 

87.4 

1912 

346,848 

416 

119.9 

1911 

169,208 

156 

92.2 

1912 

172,006 

152 

88.4 

1908-1912 

1,712,593 

2,047 

119.5 

1908-1912 

831,817 

756 

90.9 

1913 

379,128 

477 

125.8 

1913 

175,967 

154 

87.5 

Source: 

Sveriges 

officiella 

Statistik. 

Allman    Halso-    och 

Sjukvarden    for    Ar 

Source: 

Gbteborgs  Hiilsovards  Namds 

1908-1913 

Arsberattelse  for  1912-1913. 

Note: 

[ncludes  only  carcinoma. 

Note: 

Includes  only 

carcinoma. 

Table  78 

Mortality  from  Cancer  in  Cities  of  Denmark 

1881-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881- 

570,781 

593 

103.9 

1901 

958,905 

1,201 

125.2 

1882 

588,067 

606 

103.0 

1902 

971,790 

1,276 

131.3 

1883 

605,353 

641 

105.9 

1903 

984,676 

1,229 

124.8 

1884 

622,639 

686 

110.2 

1904 

997,562 

1,313 

131.6 

1885 

639,925 

726 

113.5 
107.4 

1905 
1901-1905 

1,010,448 

1,338 

132.4 

1881-1885 

3,026,765 

3,252 

4,923,381 

6,357 

129.1 

1886 

657,211 

722 

109.9 

1906 

1,023,334 

1,344 

131.3 

1887 

674,497 

775 

114.9 

1907 

1,040,473 

1,438 

138.2 

1888 

691,783 

782 

113.0 

1908 

1,057,613 

1,415 

133.8 

1889 

709,069 

866 

122.1 

1909 

1,074,753 

1,515 

141.0 

1890 

726,355 

832 

114.5 
115.0 

1910 
1906-1910 

1,091,893 

1,547 

141.7 

1886-1890 

3,458,915 

3,977 

5,288,060 

7,259 

137.3 

1891 

747,495 

927 

124.0 

1911 

1,109,033 

1,575 

142.0 

1892 

768,636 

837 

108.9 

1912 

1,120,030 

1,695 

151.3 

1893    • 

789,777 

936 

118.5 

1894 

810,918 

875 

107.9 

Source: 

Dodsaarsagerne   i    Kongeriget 

1895 

832,059 

933 

112.1 

Danmarks 

Byer. 

Note:     ] 

deaths  of  rural  patients  in  hos- 

1891-1895 

3,948,885 

4,508 

114.2 

pitals  are  excluded. 

1896 

853,190 

1,022 

119.8 

1897 

874,331 

1,054 

120.5 

1898 

895,472 

1,063 

118.7 

1899 

916,613 

1,063 

116.0 

1900 

937,754 

1,123 

119.8 
118.9 

1896-1900 

4,477,360 

5.325 

637 


APPENDIX  G 


Table  79 

Table  80 

Mortality  from  Cancer  in 
Denmark,  Males 

Cities  of 

Mortality  from  Cancer  in  Cities  of 
Denmark,  Females 

1894-1912 

Rate  per 

100,000 

Population 

Year 

1894- 

1912 

Year 

Population 

Deaths 
from 
Cancer 

Population 

Deaths 
from 
Cancer 

Rate  per 
■    100,000 
Population 

1894 

373,022 

353 

94.6 

1894 

437,896 

522 

119.2  ' 

1895 

382,747 

362 

94.6 

1895 

449,312 

571 

127.1 

1896 

392,467 

413 

105.2 

1896 

460,723 

609 

132.2 

1897 

402,192 

437 

108.7 

1897 

472,139 

617 

130.7 

1898 

411,917 

470 

114.1 

1898 

483,555 

593 

122.6 

1899 

421,642 

431 

102.2 

1899 

494,971 

632 

127.7 

1900 

431,367 

476 

110.3 
108.1 

1900 
1896-1900 

506,387 

647 

127.8 

1896-1900 

2,059,585 

2,227 

2,417,775 

3,098 

128.1 

1901 

441,096 

505 

114.5 

1901 

517,809 

696 

134.4 

1902 

447,023 

510 

114.1 

1902 

524,767 

766 

146.0 

1903 

452,951 

518 

114.4 

1903 

531,725 

711 

133.7 

1904 

458,879 

556 

121.2 

1904 

538,683 

757 

140.5 

1905 

464,806 

557 

119.8 
116.8 

1905 
1901-1905 

545,642 

781 

143.1 

1901-1905 

2,264,755 

2,646 

2,658,626 

3,711 

139.6 

1906 

470,734 

576 

122.4 

1906 

552,600 

768 

139.0 

1907 

478,618 

596 

124.5 

1907 

561,855 

842 

149.9 

1908 

486,502 

605 

124.4 

1908 

571,111 

810 

141.8 

1909 

494,386 

663 

134.1 

1909 

580,367 

852 

146.8 

1910 

502,270 

682 

135.8 
128.3 

1910 
1906-1910 

589,623 

865 

146.7 

1906-1910 

2,432,510 

3,122 

2,855,556 

4,137 

144.9 

1911 

509,285 

654 

128.4 

1911 

599,748 

921 

153.6 

1912 

514,318 

750 

145.8 

1912 

605,712 

945 

156.0 

Source:      Dodsaarsageme  i   Kongeriget 
Danmarks  Byer. 

Note:     Deaths  of  rural  patients  in  hos- 

Source: 

Danmarks 

Note: 

Dodsaarsageme   i  Kongeriget 
Byer. 
Deaths  of  rural  patients  in  hos- 

pitals  are 

excluded. 

pitals  are  excluded. 

Table  81 

Mortality  from  Cancer  in  the  Cities  of  Denmark,  by  Organs  and  Parts 

according  to  Sex,  1908-1912 


MALES 
Deaths  Rate  per 

from  100,000 

Organ  or  Part  Cancer  Population 

Stomach 1,362  54.3 

Breast 

Uterus 

Other  organs 1,992  79.5 

All  organs 3,354  133.8 

Source:    Dodsaarsageme  i  Kongeriget  Danmarks  Byer. 
Note:     Deaths  of  rural  patients  in  hospitals  are  excluded. 


FEMALES 

Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

1,327 

45.0 

750 

25.5 

439 

14.9 

1,877 

63.7 

4,393 


149.1 


638 


APPENDIX  G 


Table  82 
Mortality  from  Cancer  in  Copenhagen,  1894-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1894 

394,231 

487 

123.5 

1906 

506,931 

782 

154.3 

1895 

402,836 

513 

127.3 

1907 

517,424 

853 

164.9 

1896 
1897 
1898 

411,441 
420,046 
428,651 
437,256 
445,861 

564 
562 
626 
598 
609 

137.1 
133.8 
146.0 
136.8 
136.6 

1908 
1909 
1910 

1906-1910 

527,917 
538,410 
548,903 

802 
839 
928 

151.9 
155.8 
169.1 

1899 
1900 

2,639,585 

4,204 

159.3 

1911 
1912 

559,398 
570,000 

883 
975 

157.8 
171.1 

1896-1900 

2,143,255 

2,959 

138.1 

1901 

454,466 

668 

147.0 

Source: 

Dodsaarsagerne   i 

iongeriget 

1902 

464,959 

707 

152.1 

Danmarks  Byer. 

1903 

475,452 

700 

147.2 

Note : 

Deaths  of  rural  patients  in  hos- 

1904 

485,945 

713 

146.7 

pitals  are 

ex  eluded. 

1905 

496,438 

770 

155.1 
149.7 

1901-1905 

2,377,260 

3,558 

Tabl 

e83 

Mortality  from  Cancer  in  Cc 

>penhagen 

,  by  Sex,  1894-1912 

' 

MALES 

FEMALES 

Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1894 

181,110 

185 

102.1 

1894 

213,121 

302 

141.7 

1895 

184,821 

204 

110.4 

1895 

218,015 

309 

141.7 

1896 

188,522 

206 

109.3 

1896 

222,919 

358 

160.6 

1897 

192,213 

226 

117.6 

1897 

227,833 

336 

147.5 

1898 

195,894 

273 

139.4 

1898 

232,757 

353 

151.7 

1899 

199,564 

253 

126.8 

1899 

237,692 

345 

145.1 

1900 

203,223 

262 

128.9 
124.6 

1900 
1896-1900 

242,638 

347 

143.0 

1896-1900 

979,416 

1,220 

1,163,839 

1,739 

149.4 

1901 

206,873 

279 

134.9 

1901 

247,593 

389 

157.1 

1902 

211,370 

285 

134.8 

1902 

253,589 

422 

166.4 

1903 

215,855 

279 

129.3 

1903 

259,597 

421 

162.2 

1904 

220,327 

294 

133.4 

1904 

265,618 

419 

157.7 

1905 

224,737 

321 

142.8 
135.1 

1905 
1901-1905 

271,701 

449 

165.3 

1901-1905 

1,079,162 

1,458 

1,298,098 

2,100 

161.8 

1906 

229,133 

347 

151.4 

1906 

277,798 

435 

156.6 

1907 

233,513 

356 

152.5 

1907 

283,911 

497 

175.1 

1908 

237,879 

358 

150.5 

1908 

290,038 

444 

153.1 

1909 

242,231 

360 

148.6 

1909 

296,179 

479 

161.7 

1910 

246,567 

410 

166.3 
154.0 

1910 
1906-1910 

302,336 
1,450,262 

518 

171.3 

1906-1910 

1,189,323 

1,831 

2,373 

163.6 

1911 

250,870 

369 

147.1 

1911 

308,528 

514 

166.6 

1912 

255,645 

428 

167.4 

1912 

314,355 

547 

174.0 

Source : 

Dodsaarsag 

erne   i 

Kongeriget 

Danmarks  Byer. 

Note: 

Deaths  of  rural  patients  in  hos- 

pitals  are 

excluded. 

639 


APPENDIX  G 

Table  84 

Cancer  Census  of  Iceland,  by  Organs  and  Parts 

according  to  Sex,  1908 


Organ  or  Part 
Lips,  jaw  and  tongue. 

Stomach 

Intestines 

Breast 

Generative  organs. . . . 
Sarcoma 


MALES 

Cases  of 
Cancer 

Rate  per 

100,000 

Population 

1 

2.5 

2 

5.0 

1 

2.5 

5.0 


15.0 


FEMALES 

Cases  of 
Cancer 

Rate  per 

100,000 

Population 

2 

4.7 

4 

9.3 

1 

2.3 

5 

11.7 

5 

11.7 

17 


39.7 


All  organs 6 

Source:    Zahlung  der  Krebskranken  auf  Island.       In:    Zeitschrif t  fiir  Krebsforschung, 
13.  Band. 


Table  85 

Cancer  Census  of  Finland,  by  Organs  and  Parts 

according  to  Sex,  1909 


MALES 

Cases  of  Per 

Organ  or  Part  Cancer  Cent. 

Lips 60  24.6 

Tongue  and  mouth 15  6.1 

Oesophagus 10  4.1 

Stomach 101  41.4 

Liver  and  gall-bladder 6  2.5 

Intestines 10  4.1 

Rectum 4  1.6 

Kidney...... 3  1.2 

Vesica  urinaria 4  1.6 

Prostata  and  penis 6  2.5 

Breast 

Uterus 

Ovaries  and  generative  organs 

Cancer  cutis 16  6.6 

Other  or  not  specified  organs 9  3.7 

All  organs 244  100.0 

Source:     Zeitschrift  fiir  Krebsforschung,  12.  Band. 


FEMALES 

Cases  of 

Per 

Cancer 

Cent. 

10 

3.2 

5 

1.6 

5 

1.6 

116 

37.2 

4 

1.3 

6 

1.9 

8 

2.6 

2 

0.6 

1 

0.3 

60 

19.2 

56 

18.0 

10 

3.2 

15 

4.8 

14 

4.5 

312 


100.0 


640 


APPENDIX  G 

Table  86 

Cases  of  Cancer  in  Finland,  by  Organs  and  Parts 

1890-1907 

All  Malignant 

Carcinoma  Tumors 

Organ  or  Part                                                                                                   Per  Cent.  Per  Cent. 

Lips 18.9  15.8 

Jaw 2.8  3.9 

Mouth 3.5  3.3 

Bre£^st 10.4  9.0 

(Esophagus 2.2  1.8 

Stomach 24.2  20.3 

Intestines 1.9  1.6 

Rectum 3.9  3.3 

Liver  and  pancreas 2.2  1.9 

Female  generative  organs 11.1  10.0 

Other  or  not  specified  organs 18.9  29.1 

All  organs 100.0  100.0 

All  malignant  tumors 9,119  cases 

Carcinoma 7,613  cases 

Table  87 

Comparative  Distribution  of  Carcinoma,  by  Organs  and  Parts 

Sweden  and  Finland,  1890-1907 

Organ  or  Part                                                                                                              Sweden  Finland 

Lips 4.2  18.9 

Tongue 1.5  1.6 

Breast 12.3  10.4 

CEsophagus 3.4  2.2 

Stomach 45.3  24.2 

Intestines  and  rectum 8.6  5.8 

Liver  and  pancreas 2.6  2.2 

Female  generative  organs 10.7  11.1 

Otheror  not  specified  organs 11.4  23.6 

Source:    tjber  maligne  Tumoren  in  Finland,  1890-1907.      G.  Renwall,  In:  Zeitschrift 
f lir  Krebsforschung,  9  Band.     1910. 

Table  87a 

Mortality  from  Cancer  in  Cities  of  Finland 

1910 

Deaths  Rate  per 

Population                  from  100,000 

Cancer  Population 

Helsingfors 144,483                   95  65.8 

Abo 50,215                   46  91.6 

Tammerfors 45,078                   18  39.9 

Viborg 27,101                    16  59.0 

Nikolaistad 20,167                   17  .84.3 

Uleaborg 19,501                    10  51.3 

Bjorneborg 16,707                   19  113.7 

Thirty-one  other  cities 125,926                   88  69.9 

All  cities 449,178                 309  68.8 

Source:    Lisita  Snomen  Viralliseen  Tilastoon:    XI.    Laakintolaitos,  1910.    Helsinski, 
1912. 


641 


APPENDIX  G 

Table  88 

Mortality  from  Cancer  in  the  German  Empire 

1891-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year               Population 

from 

100,000 

Cancer 

Population 

Cancer      Population 

1891 

37,483,234 

20,043 

53.5 

1906          60,407,847 

49,127 

81.3 

1892 

47,125,446 

28,745 

61.0 

1907          61,259,086 

50,930 

83.1 

1893 

47,625,932 

30,013 

63.0 

1908          62,110.325 

51,948 

63.6 

1894 

48,259,077 

31,137 

64.5 

1909          62,953,056 

53,214 

84.5 

1895 

48,818,672 

32,071 

65.7 
61.9 

1910          63,751,143 

56,092 

88.0 

1891-1895 

229,312,361 

142,009 

1906-1910  310,481,457 

261,311 

84.2 

1896 

49,356,136 

33,620 

68.1 

1911          64,612,000 

57,519 

89.0 

1897 

49,893,600 

34,584 

69.3 

1912          65,450,000 

58,937 

90.0 

1898 

50.431,064 

35,504 

70.4 

1899 

51,843,158 

38,209 

73.7 

Source:    Statistisches 

Jahrbuch  fiir  das 

1900 

52,624,706 

37,946 

72.1 

Deutsche    Reich,     1913 

Medizinal-sta- 

tistische    Mitteilungen 
lichen  Gesundheitsamte. 

1896-1900  254,148,664 

179,863 

70.8 

Annual 

Report 

of  the  Registrar-General  of  Births 

Deaths 

1901 

53,406,252 

39,917 

74.7 

and  Marriages  in  England  and  Wales,  1910. 

1902 

54,187,799 

40,613 

74.9 

Note:     Includes    all 

kinds   of 

tumors. 

1903 

54,969,346 

42,535 

77.4 

1891,  only  for  Prussia,  B 

avaria  and  Baden. 

1904 

58,433,571 

46,723 

80.0 

1892-1903,  only  for  ten  of  the  states.  1904- 

1905 

59,413,982 

48,078 

80.9 

1912,  for  all  the  Empire 

,  except  Mecklen- 

burg-Schwerin  and  Mecklenburg-S 

1901-1905 

280,410,950 

217,866 

77.7 

Table  89 

Mortality  from  Cancer  in  the  German  Empire,  by  Sex 

1905-1912 


MALES 

FEMALES 

Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1905 

29,279,210 

21,556 

73.6 

1905 

30,134,772 

26,522 

88.0 

1906 

29,781,068 

21,936 

73.7 

1906 

30,626,779 

27,191 

88.8 

1907 

30,212,981 

22,806 

75.5 

1907 

31,046,105 

28,124 

90.6 

1908 

30,651,445 

23,225 

75.8 

1908 

31,458,880 

28,723 

91.3 

1909 

31,061,038 

23,885 

76.9 

1909 

31,892,018 

29,329 

92.0 

1910 

31,461,189 

25,001 

79.5 
76.3 

1910 
1906-1910 

32,289,954 

31,091 

96.3 

1906-1910 

153,167,721 

116,853 

157,313,736 

144,458 

91.8 

1911 

31,886,022 

25,769 

80.8 

1911 

32,725,978 

31,750 

97.0 

1912 

32,312,665 

26,442 

81.8 

1912 

33,137,335 

32,495 

98.1 

Source: 

Medizinal-statistische 

Mitteil- 

ungen  aus 

>  dem  kaiserlichen  Gesundheit- 

samte. 

Note: 

[ncludes    all 

kinds    of 

tumors. 

Does   not 

include    Mecklenburg-Schwerin 

and  Mecklenburg-Strelitz. 

642 


APPENDIX  G 


Table  90 

Table  91 

Mortality  from  Cancer  and  Other 
Tumors  in  Bavaria 

Mortality  from  Cancer  and  Other 
Tumors  in  Bavaria,  Males 

1886-1912 

Rate  per 

100,000 

Population 

Year 

1886-1912 

Year 

Population 

Deaths 
from 
Cancer 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1886 
1887 
1888 
1889 
1890 

5,455,155 
5,490,111 
5,525,068 
5,560,025 
5,594,982 

3,534 
3,516 
4,375 
4,527 
4,520 

64.8 
64.0 
79.2 
81.4 
80.8 

74.1 

1886 
1887 
1888 
1889 
1890 

1886-1890 

2,656,115 
2,674,782 
2,693,471 
2,712,736 
2,731,120 

1,492 
1,490 
1,802 
1,877 
1,867 

56.2 
55.7 
66.9 
69.2 
68.4 

1886-1890 

27,625,341 

20,472 

13,468,224 

8,528 

63.3 

1891 
1892 
1893 
1894 
1895 

5,639,694 
5,684,406 
5,729,118 
5,773,831 
5,818,544 

4,984 
4,806 
5,126 
5,318 
5,499 

88.4 
84.5 
89.5 
92.1 
94.5 

89.8 

1891 
1892 
1893 
1894 
1895 

1891-1895 

2,754,427 
2,777,401 
2,800,393 
2,823,403 
2,846,687 

2,049 
2,074 
2,208 
2,340 
2,331 

74.4 
74.7 
78.8 
82.9 
81.9 

1891-1895 

28,645,593 

25,733 

14,002,311 

11,002 

78.6 

1896 
1897 
1898 
1899 
1900 

5,890,046 
5,961,548 
6,033,051 
6,104,554 
6,176,057 

5,588 
5,750 
5,845 
6,192 
6,104 

94.9 
96.5 
96.9 
101.4 
98.8 

97.7 

1896 
1897 
1898 
1899 
1900 

1896-1900 

2,883,178 
2,919,370 
2,955,592 
2,991,842 
3,028,100 

2,426 
2,528 
2,552 
2,625 
2,668 

84.1 
86.6 
86.3 

87.7 
88.1 

1896-1900  30,165,256 

29,479 

14,778,082 

12,799 

86.6 

1901 
1902 
1903 
1904 
1905 

6,245,720 
6,315,383 
6,385,046 
6,454,709 
6,524,372 

6,407 
6,524 
6,859 

7,122 
7,074 

102.6 
103.3 
107.4 
110.3 
108.4 

106.5 

1901 
1902 
1903 
1904 
1905 

1901-1905 

3,062,277 
3,095,801 
3,129,311 
3,162,807 
3,196,647 

2,692 
2,777 
2,917 
3,068 
3,114 

87.9 
89.7 
93.2 
97.0 
97.4 

1901-1905 

31,925,230 

33,986 

15,646,843 

14,568 

93.1 

1906 
1907 
1908 
1909 
1910 

6,596,955 
6,669,539 
6,742,123 
6,814,707 
6,887,291 

7,258 
7,104 

7,274 
7,472 
7,820 

110.0 
106.5 
107.9 
109.6 
113.5 

109.5 

1906 
1907 
1908 
1909 
1910 

1906-1910 

3,233,168 
3,269,408 
3,305,663 
3,342,614 
3,379,580 

3,137 
3,075 
3,149 
3,253 
3,432 

16,046 

97.0 
94.1 
95.3 
97.3 
101.6 

1906-1910  33,710,615 

36,928 

16,530,433 

97.1 

1911 
1912 

6,959,875 
7,032,459 

7,828 
8,095 

112.5 
115.1 

1911 
1912 

3,415,907 
3,452,234 

3,426 
3,538 

100.3 
102.5 

Source:     Statistisches  Jahrbuch  fiir  das 
Konigreich  Bayern. 

Source:     Statistisches  Jahrbuch  fiir  das 
Konigreich  Bayern. 

APPENDIX  G 

Table  92 
Mortality  from  Cancer  and  Other  Tumors  in  Bavaria,  Females 

1886-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1886 

2,799,040 

2,042 

73.0 

1901 

3,183,443 

3,715 

116.7 

1887 

2,815,329 

2,026 

72.0 

1902 

3,219,582 

3,747 

116.4 

1888 

2,831,597 

2,573 

90.9 

1903 

3,255,735 

3,942 

121.1 

1889 

2,847,289 

2,650 

93.1 

1904 

3,291,902 

4,054 

123.2 

1890 

.2,863,862 

2,653 

92.6 

84.4 

1905 
1901-1905 

3,327,725 

3,960 

119.0 

1886-1890 

14,157,117 

11,944 

16,278,387 

19,418 

119.3 

1891 

2,885,267 

2,935 

101.7 

1906 

3,363,787 

4,121 

122.5 

1892 

2,907,005 

2,732 

94.0 

1907 

3,400,131 

4,029 

118.5 

1893 

2,928,725 

2,918 

99.6 

1908 

3,436,460 

4,125 

120.0 

189-t 

2,950,428 

2,978 

100.9 

1909 

3,472,093 

4,219 

121.5 

1895 

2,971,857 

3,168 

106.6 
100.6 

1910 
1906-1910 

3,507,711 

4,388 

125.1 

1891-1895 

14,643,282 

14,731 

17,180,182 

20,882 

121.5 

1896 

3,006,868 

3,162 

105.2 

1911 

3,543,968 

4,402 

124.2 

1897 

3,042,178 

3,222 

105.9 

1912 

3,580,225 

4,557 

127.3 

1898 

3,077,459 

3,293 

107.0 

1899 

3,112,712 

3,567 

114.6 

Source: 

Statistisches  Jahrbuch  fiir  das 

1900 

3,147,957 

3,436 

109.2 
108.4 

Konigreich  Bayern. 

1896-1900 

15,387,174 

16,680 

Table  93 

Mortality  from  Cancer  in  Bavaria,  by  Geographical  Divisions 

Rate  per  100,000  of  Population,  Males 

1905-1907 


Stomach 
Liver  and 
Pancreas 

Oberbayern 63.6 

Niederbayern 55.0 

Schwaben 90.0 

Oberpfalz 68.2 

Mittelf ranken 56.2 

Pfalz 47.2 

Oberf ranken 59.7 

Unterf ranken 56.7 

All  Bavaria 61.8 


ntestines 
and 

All  Organ 

Rectum 

15.4 

104.4 

7.6 

82.9 

15.1 

135.1 

9.8 

96.0 

12.2 

94.4 

6.0 

76.6 

7.4 

82.6 

9.3 

93.5 

10.9 


96.6 


Source:     K.  Kolb:     Die  Lokalisation  des  Krebses  in  den  Organen  in  Bayern.     In: 
Zeitschrift  fiir  Krebsforschung,  8.  Band. 


644 


APPENDIX  G 

Table  94 

Mortality  from  Cancer  in  Bavaria,  by  Geographical  Divisions 

Rate  per  100,000  of  Population,  Females 

1905-1907 


Stomach 
Liver  and 
Pancreas 

Oberbayern 59.2 

Niederbayern 48.2 

Schwaben 76.0 

Oberpfalz 50.0 

Mittelfranken 53.1 

Pfalz 56.3 

Oberfranken 48.6 

Unterfranken 58.1 

AllBavaria 56.7 


Intestines 

and 

Rectum 

Uterus 

Breast 

All  Organ 

11.3 

34.4 

11.9 

138.5 

6.8 

26.3 

9.9 

112.5 

12.7 

28.5 

13.0 

155.2 

8.5 

15.7 

9.0 

101.6 

9.3 

24.8 

9.0 

119.4 

6.5 

12.2 

4.9 

101.8 

8.1 

13.6 

7.3  . 

91.9 

7.9 

15.1 

8.7 

110.8 

9.1 


22.7 


9.4 


119.3 


Source:     K.  Kolb:     Die  Lokalisation  des  Krebses  in  den  Organen  in  Bayern.     In: 
Zeitschrift  fiir  Krebsforschung,  8.  Band. 

Table  95 , 
Mortality  from  Cancer  in  Bavaria,  by  Organs  and  Parts,  according  to  Sex 

1905-1910 


Organ  or  Part 

Lips  and  mouth 

CEsophagus,  stomach  and  liver 12,373 

Intestines 

Rectum 

Gall-bladder 

Pancreas - 

Peritoneum 

Larynx 

Lungs  and  pleura 

Kidneys 

Bladder 

Prostata 

Uterus 

Ovaries 

Vagina 

Breast 

Brain 

Skin 

Head  and  extremities 

Other  organs 

Not  specified 


M. 

i.LES 

FEIHALES 

Deaths 

Rate  per 

Deaths 

Rate  per 

from 

100,000 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

335 

1.7 

140 

0.7 

12,373 

62.9 

11,291 

55.0 

1,090 

5.5 

1,222 

6.0 

1,068 

5.4 

709 

3.5 

66 

0.3 

181 

0.9 

108 

0.5 

98 

0.5 

371 

1.9 

1,079 

5.3 

183 

0.9 

45 

0.2 

163 

0.8 

140 

0.7 

162 

0.8 

109 

0.5 

605 

3.1 

187 

0.9 

204 

1.0 

o    • 

3,933 

19.2 

396 

1.9 

105 

0.5 

13 

0.1 

1,871 

9.1 

158 

0.8 

168 

0.8 

124 

0.6 

187 

0.9 

659 

3.3 

716 

3.5 

223 

1.1 

319 

1.6 

347 

1.8 

502 

2.4 

All  organs 18,252  92.5  23,398  114.1 

Source:     Bericht  tiber  das  Bayerlsche  Gesundheitswesen.     Miinchen,  1912. 


64c 


APPENDIX  G 

Table  95a 

Mortality  from  Cancer  in  Bavaria,  by  Age 

1901-1912 


Rate  peb  100,000  of  Population 

Age  1901-1910  1910  1911  1912 

Under  1 6.0  3.9  3.9  2.2 

1-4 3.3  4.1  3.3  3.0 

5-14 2.0  1.8  1.8  1.4 

15-19 3.6  2.5  2.6  2.8 

20-29 8.1  6.9  7.4  8.7 

a}-39 39.9  39.9  37.0  42.3 

40-49 139.5  136.7  142.0  153.1 

50-59 334.1  360.5  349.4  351.4 

60-69 647.4  681.6  670.5  683.5 

70-79 808.5  917.8  948.8  936.2 

80  and  over 663.9  745.2  724.3  777.6 

All  ages 108.0  113.5  112.5  115.1 

Source:    Bericht  iiber  das  Bayerische  Gesundheitswesen,  39.  Band,  die  Jahre,  1911 
und  1912,  umfassend. 


Table  96 

Mortality  from  Cancer  in  Prussia 

1881-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

27,400,370 

8,525 

31.1 

1901 

34,801,604 

21,488 

61.7 

1882 

27,608,242 

8,778 

31.8 

1902 

35,365,767 

21,876 

61.9 

1883 

27,816,114 

9,383 

33.7 

1903 

35,929,930 

23,420 

65.2 

1884 

28,023,986 

9,865 

35.2 

1904 

36,494,093 

25,050 

68.6 

1885 

28,231,858 

10,108 

35.8 
33.5 

1905 
1901-1905 

37,058,256 

25,704 

694 

1881-1885 

139,080,570 

46,659 

179,649,650 

117,538 

654 

1886 

28,509,431 

10,919 

38.3 

1906 

37,628,378 

26,498 

70.4 

1887 

28,836,793 

10,981 

38.1 

1907 

38,202,757 

28,034 

73.4 

1888 

29,164,155 

11,906 

40.8 

1908 

38,777,136 

28,531 

73.6 

1889 

29,491,517 

12,819 

43.5 

1909 

39,351,515 

29,429 

74.8 

1890 

29,818,879 

12,904 

43.3 
40.8 

1910 
1906-1910 

39,925,894 

31,340 

78.5 

1886-1890 

145,820,775 

59,529 

193,885,680 

143,832 

74.2 

1891 

30,176,929 

13,487 

44.7 

1911 

40,500,273 

32,660 

80.6 

1892 

30,556,897 

15,122 

49.5 

1912 

41,074,652 

33,463 

81.5 

1893 

30,936,865 

15,740 

50.8 

1894 

31,316,833 

16,480 

52.6 

Source: 

Tables  96-98 

Annual  Reports  of 

1895 

31,696,801 

16,850 

53.2 

the  Regist 

rar-General  of  Births,  Deaths  and 

50.2 

Marriages  in  England  and  W  ales 
Statistisches  Jahrbuch  fiir  den 

1891-1895 

154,084,325 

77,679 

Preussi- 

schen  Staat. 

1896 

32,160,485 

17,643 

54.9 

Das  Gesundheitswesen  des  Preussischen 

1897 

32,GS3,!}G2 

18,315 

56.0 

Staat. 

1898 

33,207,439 

18,695 

56.3 

Note: 

Includes  all  tumors. 

1899 

33,730,916 

20,011 

59.3 

1900 

34,254,393 

20,430 

59.6 
57.3 

1896-1900 

166,037,195 

95,094 

646 


APPENDIX  G 


Table  97 

Table  98 

Mortality  from  Cancer  in  Prussia 

Mortality  from  Cancer  in 

Prussia 

Males,  1898 

-1912 

Deaths 

Rate  per 

Females,  1898-1912 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1898 

16,334,739 

8,595 

52.6 

1898 

16,872,700 

10,100 

59.9 

1899 

16,598,984 

9,055 

54.6 

1899 

17,131,932 

10,956 

64.0 

1900 

16,863,438 

9,418 

55.8 

1900 

17,390,955 

11,012 

63.3 

1901 

17,143,270 

9,776 

57.0 

1901 

17,658,334 

11,712 

66.3 

1902 

17,428,250 

10,011 

57.4 

1902 

17,937,517 

11,865 

66.1 

1903 

17,713,455 

10,627 

60.0 

1903 

18,216,475 

12,793 

70.2 

1904 

17,998,887 

11,454 

63.6 

1904 

18,495,206 

13,596 

73.5 

1905 

18,284,544 

11,609 

63.5 
60.4 

1905 
1901-1905 

18,773,712 

14,095 

75.1 

1901-1905 

88,568,406 

53,477 

91,081,244 

64,061 

70.3 

1906 

18,573,367 

11,972 

64.5 

1906 

19,055,011 

14,526 

76.2 

1907 

18,864,521 

12,726 

67.5 

1907 

19,338,236 

15,308 

79.2 

1908 

19,155,905 

12,874 

67.2 

1908 

19,621,231 

15,657 

79.8 

1909 

19,443,584 

13,386 

68.8 

1909 

19,907,931 

16,043 

80.6 

1910 

19,731,377 

14,155 

71.7 
68.0 

1910 
1906-191C 

20,194,517 

17,185 

85.1 

1906-1910 

95,768,754 

65,113 

98,116,926 

78,719 

80.2 

1911 

20,023,335 

14,754 

73.7 

1911 

20,476,938 

17,906 

87.4 

1912 

20,315,293 

15,142 

74.5 

1912 

20,759,359 

18,321 

88.3 

Table  98a 

Mortality  from  Cancer  in  Prussia,  by  Age  and  Sex 

Rate  per  100,000  of  Population 

1903-1913 


TOTAL 

MALES 

FEMALES 

Year 

Ages 

Under 

30 

Ages 
30-59 

Ages 

60 

and  Over 

Ages 

Under 

30 

Ages 
30-59 

Ages 

60 

and  Over 

Ages 

Under 

30 

Ages 
30-59 

Ages 

60 

and  Over 

1903... 

.    1.4 

92.0 

404.7 

1.1 

81.7 

431.9 

1.8 

101.8 

328.6 

1904... 

.    1.6 

95.4 

427.2 

1.3 

86.1 

458.5 

2.0 

104.2 

401.7 

1905 . . . 

.    1.5 

93.6 

439.5 

1.2 

82.8 

464.0 

1.7 

103.9 

419.6 

1906... 

.    1.6 

94.5 

446.6 

1.2 

82.9 

474.1 

1.9 

105.7 

424.5 

1907... 

.    1.5 

97.4 

464.6 

1.3 

85.6 

493.6 

1.6 

108.7 

441.3 

1908... 

.    1.4 

98.5 

464.9 

1.0 

87.0 

491.0 

1.8 

109.6 

444.0 

1909... 

.    1.6 

99.1 

476.6 

1.4 

87.8 

507.0 

1.7 

109.8 

452.3 

1910... 

.    1.5 

103.7 

502.8 

1.2 

90.7 

534.1 

1.8 

116.2 

477.8 

1911... 

.    1.5 

101.6 

524.9 

1.4 

89.5 

552.6 

1.7 

113.2 

503.0 

1912... 

.    1.5 

100.0 

535.9 

1.3 

86.6 

574.0 

1.6 

112.8 

505.7 

1913... 

.    1.6 

101.3 

541.6 

1.4 

86.6 

576.9 

1.7 

115.5 

513.8 

Source:  Statistisches  Jahrbuch  fiir  den  Preussischen  Staat,  1914. 
Note:  Includes  only  carcinoma. 


647 


APPENDIX  G 


Table  99 

Table  100 

Mortality  from  Cancer  in  Wiirttem- 

Mortality  from  Cancer  in 

Baden 

berg,  by  Sex 
1904-1912 

1881-1912 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

TOTAL 

Cancer 

Population 

Year 

Population 

Deaths 
from 

Rate  per 
100,000 

1881 

1882 

1,573,873 
1,580,073 

1,189 
1,263 

75.5 
79.9 

Cancer 

Population 

1883 

1,586,273 

1,238 

78.0 

1904 

2,275,100 

1,967 

86.5 

1884 

1,592,473 

1,240 

77.9 

1905 

2,302,179 
2,329,258 

2,124 
2,053 

92.3 
88.1 

1885 
1881-1885 

1,598,673 

1,322 

82.7 

1906 

7,931,365 

6,252 

78.8 

1907 
1908 
1909 
1910 

2,356,337 
2,383,416 
2,410,495 
2,437,574 

2,162 
2,215 
2,307 
2,344 

91.8 
92.9 
95.7 
96.2 

93.0 

92.9 

1886 
1887 
1888 
1889 
1890 

1886-1890 

1,607,863 
1,619,108 
1,630,421 
1,641,825 
1,653,307 

1,454 
1,363 
1,412 
1,480 
1,532 

90.4 
84.2 
86.6 
90.1 

1906-1910 

11,917,080 
2,464,700 

11,081 

2,289 

92.7 

1911 

8,152,524 

7,241 

88.8 

1912 

2,491,826 

2,511 

100.8 

1891 

1,666,611 

1,572 

94.3 

1892 

1,680,022 

1,504 

89.5 

MALES 

1893 

1,693,540 

1,643 

97.0 

1904 

1,109,339 

853 

76.9 

1894 

1,707,158 

1,636 

95.8 

1905 

1,122,914 
1,136,911 

958 
924 

85.3 
81.3 

1895 
1891-1895 

1,720,904 

1,719 

99.9 

1906 

8,468,235 

8,074 

95.3 

1907 
1908 

1,150,835 
1,164,775 

961 
963 

83.5 
82.7 

1896 

1,748,500 

1,824 

104.3 

1909 

1,178,732 

1,005 

85.3 

1897 

1,776,539 

1,750 

98.5 

1910 

1,192,392 

1,013 

85.0 

1898 

1,805,026 

1,841 

102.0 

83.6 
86.1 

1899 
1900 

1896-1900 

1,833,988 
1,863,384 

1,858 
1,882 

101.3 

1906-1910 

5,823,645 
1,205,731 

4,866 
1,038 

101.0 

1911 

9,027,437 

9,155 

101.4 

1912 

1,219,070 

1,105 

90.6 

1901 

1,890,934 

2,055 

108.7 

T?T?A  T  A  T  "L 

^ 

1902 

1,918,890 

2,097 

109.3 

1  tMALbo 

1903 

1,947,258 

2,088 

107.2 

1904 

1,165,761 

1,114 

95.6 

1904 

1,976,044 

2,235 

113.1 

1905 

1,179,265 
1,192,347 

1,166 
1,129 

98.9 
94.7 

1905 
1901-1905 

2,006,168 

2,205 

109.9 

1906 

9,739,294 

10,680 

109.7 

1907 

1,205,502 

1,201 

99.6 

1908 

1,218,641 

1,252 

102.7 

1906 

2,031,921 

2,125 

104.6 

1909 

1,231,763 

1,302 

105.7 

1907 

2,058,004 

2,101 

102.1 

1910 

1,245,182 

1,331 

106.9 

1908 

2,084,421 

2,225 

106.7 

102.0 
99.4 

1909 
1910 

1906-1910 

2,111,176 
2,138,273 

2,343 

2,428 

111.0 

1906-1910 

6,093,435 
1,258,969 

6,215 
1,251 

113.5 

1911 

10,423,795 

11,222 

107.7 

1912 

1,272,756 

1,406 

110.5 

1911 

2,164,694 

2,419 

111.7 

1912 

2,191,115 

2,452 

111.9 

Source: 

Statistisch 

es    Handbuch    fur 

das  Konigreich  Wurttemberg. 

Source: 

Die  Statistik  des  Bewegung  der 

Note:    ] 

ncludes  only 

carcinoma. 

Bevolkerung  sowie  die  medizinische  und  ge- 

burtshiifliche  Statistik. 

Statistische  Mit- 

teilungen  liber  das  Groszherzogtum  Baden. 

Note: 

The  data  for  1905  and  later  years 

include  only  carcinoma 

648 


APPENDIX  G 

Table  101 

Mortality  from  Cancer  in  Baden,  by  Sex 

1905-1912 


MALES 

FEMALES 

Year 
1905 

Population 

993,454 

Deaths 

from 

Cancer 

979 

Rate  per 

100,000 

Population 

98.5 

Year 
1905 

Population 
1,012,714 

Deaths 

from 

Cancer 

1,226 

Rate  per 

100,000 

Population 

121.1 

1906 
1907 
1908 
1909 
1910 

1,006,004 
1,018,506 
1,031,372 
1,044,399 
1,057,376 

947 

989 

986 

1,049 

1,121 

94.1 

97.1 

95.6 

100.4 

106.0 

98.7 

1906 
1907 
1908 
1909 
1910 

1906-1910 

1,025,917 
1,039,498 
1,053,049 
1,066,777 
1,080,897 

1,178 
1,112 
1,239 
1,294 
1,307 

114.8 
107.0 
117.7 
121.3 
120.9 

1906-1910 

5,157,657 

5,092 

5,266,138 

6,130 

116.4 

1911 
1912 

1,070,225 
1,083,074 

1,167 
1,083 

109.0 
100.0 

1911 
1912 

1,094,469 
1,108,041 

1,252 
1,369 

114.4 
123.6 

Source:     Die  Statistik  des  Bewegung  der  Bevolkerung  sowie  die  medizinische  und 
gebiirtshilfliche  Statistik.     Statistische  Mitteilungen  iiber  das  Groszherzogtum  Baden. 
Note:     Includes  only  carcinoma. 


Table  102 

Mortality  from  Cancer  in  the  Kingdom  of  Saxony,  by  Sex 

1904-1912 


TOTAL 

FEMALES 

Year 

1904 
1905 

Population 

4,416,686 
4,478,963 

Deaths 
from 
Cancer 

3,533 
3,701 

Rate  per 

100,000 

Population 

80.0 

82.6 

Year 

1904 
1905 

Population 

2,279,893 
2,314,280 

Deaths 
from 
Cancer 

1,961 
2,013 

Rate  per 

100,000 

Population 

86.0 
87.0 

1906 
1907 
1908 
1909 
1910 

4,551,500 
4,622,400 
4,690,700 
4,749,900 
4,778,000 

3,843 
4,012 
3,916 
3,948 
3,994 

84.4 
86.8 
83.5 
83.1 
83.6 

84.3 

1906 
1907 
1908 
1909 
1910 

1906-1910 

2,351,760 
2,387,932 
2,423,216 
2,453,323 

2,467,837 

2,125 
2,261 
2,171 
2,167 

2,227 

90.4 
94.7 
89.6 
88.3 
90.2 

1906-1910 

23,392,500 

19,713 

12,084,068 

10,951 

90.6 

1911 
1912 

4,810,000 
4,840,000 

4,172 
4,200 

86.7 
86.8 

1911 
1912 

2,484,365 
2,499,860 

2,303 

2,280 

92.7 
91.2 

1904 
1905 

MALES 
2,136,793 
2,164,683 

1,572 
1,688 

73.6 
78.0 

Source:     Statistisches  Jahrbuch  fiir  das 
Konigreich  Sachsen. 

Note:     Includes  only  carcinoma. 

1906 
1907 
1908 
1909 
1910 

2,199,740 
2,234,468 
2,267,484 
2,296,577 
2,310,163 

1,718 
1,751 
1,745 
1,781 
1,767 

78.1 
78.4 
77.0 
77.6 
76.5 

77.5 

1906-1910 

11,308,432 

8,762 

1911 
1912 

2,325,635 
2,340,140 

1,869 
1,920 

80.4 
82.0 

649 


APPENDIX  G 


Table  103 

Table  104 

Mortality  from  Cancer  in 

Alsace- 

Mortality  from  Cancer  in  Heligoland 

Lorraine,  19 

05-1912 

Deaths 

Rate  per 

1840-1903 

D 

Year 

Population 

from 
Cancer 

100,000 
Population 

Years 

Population             from 
Cancer 

100,000 
Population 

1905 

1,807,200 

1,498 

82.9 

1840-1850 

18,000 

6 

33.3 

1851-1860 

17,400 

2 

11.5 

1906 

1,822,000 

1,414 

77.6 

1861-1870 

18,500 

1 

5.4 

1907 

1,834,100 

1,477 

80.5 

1871-1880 

19,700 

14 

71.1 

1908 

1,845,500 

1,543 

83.6 

1881-1890 

21,000 

U 

71.4 

1909 

1,856,600 

1,496 

80.6 

1891-1900 

22,300 

13 

58.3 

1910 

1,868,900 

1,516 

81.1 
80.7 

1901-1903 
1840-1903 

7,100 

10 
61 

140.8 

1906-1910 

9,227,100 

7,446 

124,000 

49.2 

1911 

1,875,900 

1,546 

82.4 

Source : 

I/indemann: 

tJber    Krebs- 

1912 

1,883,000 

1,551 

82.4 

statistik  auf  Helgoland.    In 

:  Zeitschrift  f iir 

Krebsforschune.  1.  Band. 

Source: 

Statistisches    Jakrbuch    ftir 

Elsass-Lothringen . 

Note: 

Includes  only 

carcinoma. 

Table  103a 

Mortality  from  Cancer  and  Other  Tumors,  by  Age  and  Sex,  according  to 

Religious  Confession,  in  the  Grand-Duchy  of  Hesse,  1901-1912 


NuMBEB  OP  Deaths  from  Cancer 


Christians  (1906-1910) 


Ages 

Under  1 

1-14 

15-29 

30-59 

60-69 

70  and  over . 


Males 


Females 


All  ages 2,689 


Ages 
Under  1 .... , 

1-14 

15-29 

30-59 

60-69 

70  and  over . 


35 

31 

47 

60 

962 

1,471 

975 

1,189 

668 

796 

2,689 

3,553 

Rate  per  10 

Christians 

(1906-1910) 

Males 

Females 

2 

7 

4 

3 

6 

8 

101 

149 

651 

686 

877 

893 

Jews  (1901-1912) 


Males 

i 
1 

43 
63 
60 

168 


Females 


6 

102 
74 

85 


267 


All  ages. 


116 


Jews  (1901-1912) 


Males 


611 
1,044 

119 


Females 


16 

177 

634 

1,342 

177 


Source:  Die  gegenwartige  Sterblichkeit  der  jiidischen  und  christlichen  Bevol- 
kerung  des  Groszherzogtums  Hessen  nach  Geschlecht,  Alter  und  Todesursachen.  Von 
Regierungsrat  Knopfel,  Darmstadt. 


050 


APPENDIX  G 

Table  105 

Mortality  from  Cancer  in  Heligoland,  by  Organs  and  Parts 

according  to  Sex,  1840-1903 


Absolute  Figdres 

Per  Cent. 

OF  Total 

Organ  or  Part 

Males 

Females 

Males 

Females 

Lips 

3 

15.7 

Tongue 

2 

4.8 

Throat 

1 

5.3 

Stomach 

13 

18 

68.4 

42.8 

Liver 

1 

2 

2 

5.3 

4.8 

Peritoneum 

4.8 

Intestines 

1 

5.3 

Breast 

8 

19.6 

Uterus 

5 

11.9 

Not  specified 

19 

5 

42 

11.9 

All  organs 

100.0 

100.0 

Source:      Lindemann:    tJber    Krebsstatistik    auf    Helgoland.      In:    Zeitschrift    fiir 
Krebsforschung,  1.  Band. 


Table  106 

Mortality  from  Cancer  in  Hamburg,  by  Sex 

1900-1912 


TOTAL 

MALES 

Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1900 

761,130 

769 

101.0 

1907 

456,745 

442 

96.8 

1908 

469,165 

488 

104.0 

1901 

780,190 

773 

99.1 

1909 

481,421 

462 

96.0 

1902 

797,850 

805 

100.9 

1910 

497,799 

475 

95.4 

1903 

814,290 

878 

107.8 

1904 

834,996 

908 

108.7 

1911 

512,942 

443 

86.4 

1905 

862,443 

945 

109.6 
105.4 

1912 

529,899            470 
FEMALES 

88.7 

1901-1905 

4,089.769 

4,309 

1907 

463,369 

528 

113.9 

1906 

889,951 

898 

100.9 

1908 

475,209 

550 

115.7 

1907 

920,114 

970 

105.4 

1909 

486,844 

546 

112.2 

1908 

944,374 

1,038 

109.9 

1910 

502,601 

607 

120.8 

1909 

968,265 

1,008 

104.1 

1910 

1,000,400 

1,082 

108.2 

1911 

517,062 

604 

116.8 

1912 

533,302 

631 

118.3 

1906-1910 

4,723,104 

4,996 

105.8 

Source: 

Bericht  iiber  die  Medizinische 

1911 

1,030,004 

1,047 

101.7 

Statistik  des  Hamburgischen  Staates. 

1912 

1,063,201 

1,101 

103.6 

651 


APPENDIX  G 

Table  107 

Mortality  from  Cancer  in  Bremen 

1896-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1896 

195,042 

196 

100.5 

1906 

263,323 

249 

94.6 

1897 

200,609 

190 

94.7 

1907 

271,374 

300 

110.5 

1898 

206,176 

176 

85.4 

1908 

279,425 

302 

108.1 

1899 

211,723 

197 

93.0 

1909 

287,476 

300 

104.4 

1900 

217,315 

199 

91.6 
92.9 

1910 

1906-1910 

295,527 

311 

105.2 

1896-1900 

1,030,865 

958 

1,397,125 

1,462 

104.6 

1901 

225,240 

191 

84.8 

1911 

305,724 

298 

97.5 

1902 

231,427 

214 

92.5 

1912 

316,000 

335 

106.0 

1903 

238,896 

268 

112.2 

1913 

326,000 

320 

98.2 

1904 

244,733 

227 

92.8 

1905 

255,272 

258 

101.1 

Source : 

Jahrbuch 

fur  Bremische  Sta- 

tistik. 
Note: 

1901-1905 

1,195,568 

1,158 

96.9 

Includes  all  kinds  of  t 

umors 

Table  108 

Mortality  from  Cancer  in  Bremen,  by  Sex 

1896-1911 


MALES 

FEiLAXES 

Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year    . 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1896 

97,404 

81 

83.2 

1896 

97,638 

115 

117.8 

1897 

100,184 

81 

80.9 

1897 

100,425 

109 

108.5 

1898 

102,964 

64 

62.2 

1898 

103,212 

112 

108.5 

1899 

105,734 

87 

82.3 

1899 

105,989 

110 

103.8 

1900 

108,527 

83 

76.5 
76.9 

1900 
1896-1900 

108,788 

116 

106.6 

1896-1900 

514,813 

396 

516,052 

562 

108.9 

1901 

112,485 

81 

72.0 

1901 

112,755 

110 

97.6 

1902 

115,575 

103 

89.1 

1902 

115,852 

111 

95.8 

1903 

119,305 

107 

89.7 

1903 

119,591 

161 

134.6 

1904 

122,220 

111 

90.8 

1904 

122,513 

116 

94.7 

1905 

127,483 

118 

92.6 

87.1 

1905 
1901-1905 

127,789 

140 

109.6 

1901-1905 

597,068 

520 

598,500 

638 

106.0 

1906 

131,504 

103 

78.3 

1906 

131,819 

146 

110.8 

1907 

135,307 

125 

92.4 

1907 

136,067 

175 

128.6 

1908 

139,070 

125 

89.9 

1908 

140,355 

177 

126.1 

1909 

142,818 

135 

94.5 

1909 

144,658 

165 

114.1 

1910 

146,552 

129 

88.0 

88.7 

1910 
1906-1910 

148,975 

182 

122.2 

1906-1910 

695,251 

617 

701,874 

845 

120.4 

1911 

150,756 

121 

80.3 

1911 

154,968 

177 

114.2 

Source: 

Jahrbuch 

flir  Bremische  Sta- 

tistik. 

Note: 

Includes  all  kinds  of  tumors. 

652 


APPENDIX  G 


Table  109 

Table  110 

Mortality  from  Cancer  in 

Berlin 

Mortality  from  Cancer  in 

Berlin 

1881-19 

12 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Males,  1881 

Population 

-1912 

Deaths 
from 
Cancer 

Year 

Population 

Rate  per 

100,000 

Population 

1881 
1882 
1883 
1884 
1885 

1,158,559 
1,196,205 
1,232,716 
1,271,677 
1,315,665 

749 
811 
845 
965 
915 

64.6 
67.8 
68.5 
75.9 
69.5 

69.4 

1881 
1882 
1883 
1884 
1885 

1881-1885 

557,810 
574,735 
591,792 
609,774 
630,859 

304 
274 
290 
375 
338 

54.5 
47.7 
49.0 
61  5 
53.6 

1881-1885 

6,174,822 

4,285 

2,964,970 

1,.581 

53.3 

188G 
1887 
1888 
1889 
1890 

1,363,220 
1,414,969 
1,471,972 
1,528,681 
1,578,516 

1,034 
1,059 
1,160 
1,279 
1,222 

75.8 
74.8 

78.8 
83.7 

77.4 

78.2 

1886 
1887 
1888 
1889 
1890 

1886-1890 

6.54,598 
680,269 
707,164 
734,925 
757,963 

367 
367 
443 
485 
467 

56.1 
53.9 
62.6 
66.0 
61.6 

1886-1890 

7,357,358 

5,754 

3,534,919 

2,129 

60.2 

1891 
1892 
1893 
1894 
1895 

1,606,617 
1,622,477 
1,640,994 
1,656,074 
1,678,924 

1,303 
1,335 
1,411 
1,526 
1,622 

81.1 
82.3 
86.0 
92.1 
96.6 

87.7 

1891 
1892 
1893 
1894 
1895 

1891-1895 

768,643 
772,777 
781,069 
786,093 
797,868 

521 
534 
548 
599 
671 

67.8 
69.1 
70.2 
76.2 
84.1 

1891-1895 

8,205,086 

7,197 

3,906,450 

2,873 

73.5 

1896 
1897 
1898 
1899 
1900 

1,721,855 
1,756,398 
1,803,211 
1,846,217 
1,888,313 

1,765 
1,704 
1,822 
1,971 
2,119 

102.5 
97.0 
101.0 
106.8 
112.2 

104.0 

1896 
1897 
1898 
1899 
1900 

1896-1900 

817,980 
831,768 
855,572 
878,389 
901,847 

716 
690 
761 
806 
891 

87.5 
83.0 
88.9 
91.8 
98.8 

1896-1900 

9,015,994 

9,381 

4,285,556 

3,864 

90.2 

1901 
1902 
1903 
1904 
1905 

1,893,941 
1,911,628 
1,946,076 
1,988,742 
2,042,402 

2,180 
2,170 
2,271 
2,4Y9 
2,557 

115.1 
113.5 
116.7 
124.7 
125.2 

119.2 

1901 
1902 
1903 
1904 
1905 

1901-1905 

899,710 
907,477 
927,687 
953,119 
985,093 

943 

887 

935 

1,001 

1,066 

104.8 
97.7 
100.8 
105.0 
108.2 

1901-1905 

9,782,789 

11,657 

4,673,086 

4,832 

103.4 

1906 
1907 
1908 
1909 
1910 

2,073,521 
2,076,437 
2,057,274 
2,057,610 
2,071,907 

2,648 
2,693 
2,639 
2,782 
2,751 

127.7 
129.7 
128.3 
135.2 
132.8 

130.7 

1906 
1907 
1908 
1909 
1910 

1906-1910 

1,002,518 
999,919 
985,355 
985,615 
994,297 

1,081 
1,110 
1,085 
1,174 
1,154 

107.8 
111.0 
110.1 
119.1 
116.1 

1906-1910 

10,336,749 

13,513 

4,967,704 

5,604 

112.8 

1911 
1912 

2,084,045 
2,100,000 

2,870 
2,789 

137.7 
132.8 

1911 
1912 

1,001,229 
1,005,000 

1,165 
1,148 

116.4 
114.2 

Source:        Statistisch 
Stadt  Berlin.     Tabellen 

2S    Jahrbuch    der 
uber  die   Bevol- 

Source:        Statistisches    Jahrbuch     der 
Stadt  Berlin.     Tabellen   iiber   die    Bevol- 

kerungsvorgange  Berlins. 

Note:     Includes  all  kinds  of  tumors. 

kerungsvorgange  Berlins. 

Note:     Includes  all  kinds  of  tumors. 

653 


APPENDIX  G 


Table  111 

Table  112 

Mortality  from  Cancer  in 

Berlin 

Mortality  from  Cancer 

in 

Females,  1881-1912 

Frankfurt 

a/M. 

1891-19i.^ 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Cancer 

Population 

Deaths 

Rate  per 

1881 
1882 

600,749 
621,470 

445 
537 

74.1 
86.4 

Year 

Population 

from 
Cancer 

100,000 
Population 

1883 

640,924 

555 

86.6 

1891 

185,000 

193 

104.3 

1884 

661,903 

590 

89.1 

1892 

189,000 

180 

95.2 

1885 

684,806 

577 

84.3 

1893 

193,300 

190 

98.3 

84.2 
94.1 

1894 
1895 

1891-1895 

199,600 
226,400 

182 
193 

91.2 

1881-1885 

3,209,852 
708,622 

2,704 
667 

85.2 

1886 

993,300 

938 

94.4 

1887 

734,700 

692 

94.2 

1888 

764,808 

717 

93.7 

1896 

233,500 

211 

90.4 

1889 

793,756 

794 

100.0 

1897 

240,500 

209 

86.9 

1890 

820,553 

755 

92.0 

1898 

247,400 

249 

100.6 

1899 

257,400 

256 

99.5 

1886-1890 

3,822,439 
837,974 

3,625 

782 

94.8 
93.3 

1900 
1896-1900 

285,000 

228 

80.0 

1891     - 

1,263,800 

1,153 

91.2 

1892 

849,700 

801 

94.3 

1893 

859,925 

863 

100.4 

1901 

294,000 

254 

86.4 

1894 

869,981 

927 

106.6 

1902 

302,000 

270 

89.4 

1895 

881,056 

951 

107.9 

1903 

310,000 

334 

107.7 

1904 

320,000 
330,000 

307 

95.9 

1891-1895 

4,298,636 
903,875 

4,324 
1,049 

100.6 
116.1 

1905 
1901-1905 

316 

95!8 

1896 

1,556,000 

1,481 

95.2 

1897 

924,630 

1,014 

109.7 

1898 

947,639 

1,061 

112.0 

1906 

340,000 

322 

94.7 

1899 

967,828 

1,165 

120.4 

1907 

349,000 

337 

96.6 

1900 

986,466 

1,228 

124.5 

1908 

358,000 

357 

99.7 

1909 

367,000 

350 

95.4 

1896-1900 

4,730,438 
994,231 

5,517 
1,237 

116.6 
124.4 

1910 
1906-1910 

410,000 

388 

94.6 

1901 

1,824,000 

1,754 

96.2 

1902 

1,004,151 

1,283 

127.8 

1903 

1,018,389 

1,336 

131.2 

1911 

419,000 

403 

96.2 

1904 

1,035,623 

1,478 

142.7 

1912 

428,500 

352 

82.1 

1905 

1,057,309 

1,491 

141.0 
133.6 

1913 

Source: 

438,000 
Tabellarische 

403 
tJbersic 

92.0 

1901-1905 

5,109,703 

6,825 

hten    be- 

treffend  den  Zivilstand  der  Stadt  Frank- 

1906 

1,071,003 

1,567 

146.3 

furt  am  "M 

ain. 

1907 

1,076,518 

1,583 

147.0 

Note: 

ncludes  only 

carcinoma. 

1908 

1,071,919 

1,554 

145.0 

1909 

1,071,995 

1,608 

150.0 

1910 

1,077,610 

1,597 

148.2 
147.3 

1906-1910 

5,369,045 

7,909 

1911 

1,082,816 

1,705 

157.4 

1912 

1.095,000 

1,641 

149.9 

Source: 

Statistisches    Jahrbuch     der 

Stadt  Berl 

in.     Tabellen 

liber  die  Bevbl- 

kerungsvorgange  Berlins. 

Note:     Includes  all  kinds  of  tumors. 

654 


APPENDIX  G 

Table  113 
Mortality  from  Cancer  in  Frankfurt  a/M. 
1892-1913 


Males 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1892 

89,643 

50 

55.8 

1906 

165,138 

131 

79.3 

1893 

91,663 

68 

74.2 

1907 

169,474 

133 

78.5 

1894 

94,630 

75 

79.3 

1908 

173,809 

159 

91.5 

1895 

107,314 

84 

78.3 

1909 

178,142 

134 

75.2 

1910 

198,932 

158 

79.4 

1892-1895 

383,250 

277 

72.3 

1906-1910 

885,495 

715 

80.7 

1896 

111,123 

78 

70.2 

1897 

114,911 

84 

73.1 

1911 

203,257 

161 

79.2 

1898 

118,678 

100 

84.3 

1912 

207,823 

153 

73.6 

1899 

123,938 

99 

79.9 

1913 

212,000 

161 

75.9 

1900 

137,741 

98 

71.1 

Source:    Tabellarische 
treffend  den  Zivilstand 

TT1              "     1,^4.               r 

1896-1900 

606,391 

459 

75.7 

der  Sta 

dt  Frank- 

flirt  am  Main. 

1901 

142,237 

93 

65.4 

Note: 

Includes  only 

carcinoma. 

1902 

146,259 

126 

86.1 

1903 

150,288 

145 

96.5 

1904 

155,296 

122 

78.6 

1905 

160,314 

117 

73.0 
79.9 

1901-1905 

754,394 

603 

Table  114 

Mortality  from  Cancer  in  Frankfurt  a/M.,  Females 

1892-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1892 

99,357 

130 

130.8 

1906 

174,862 

191 

109.2 

1893 

101,637 

122 

120.0 

1907 

179,526 

204 

113.6 

1894 

104,970 

107 

101.9 

1908 

184,191 

198 

107.5 

1895 

119,086 

109 

91.5 

1909 

188,858 

216 

114.4 

1910 

211,068 

230 

109.0 

1892-1895 

425,050 

468 

110.1 

1906-1910 

938,505 

1,039 

110.7 

1896 

122,377 

133 

108.7 

1897 

125,589 

125 

99.5 

1911 

215,743 

242 

112.2 

1898 

128,-722 

149 

115.8 

1912 

220,677 

199 

90.2 

1899 

133,462 

157 

117.6 

1913 

226,000 

242 

107.1 

1900 

147,259 

130 

88.3 

Source:   Tabellarische 
treffend  den  Zivilstand 

TTl                 •      "1    4.                   1 

1896-1900 

657,409 

694 

105.6 

der  Sta 

dt  Frank- 

furt  am  Main. 

1901 

151,763 

161 

106.1 

Note: 

Includes  only 

carcinoma. 

1902 

155,741 

144 

92.5 

1903 

159,712 

189 

118.3 

1904 

164,704 

185 

112.3 

1905 

169,686 

199 

117.3 

109.5 

1901-1905 

801,606 

878 

655 


APPENDIX  G 

Table  115 

Mortality  from  Cancer  in  Frankfurt  a/M.,  by  Organs  and  Parts 

according  to  Sex,  1906-1912 


MALES 


Organ  or  Part 

Skin 

Digestive  organs .  . . 
Respiratory  organs. 
Urinary  organs .  .  .  . 
Generative  organs. . 

Other  organs 

Sarcoma 

Other  organs 


Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

7 

0.5 

869 

67.0 

50 

3.9 

41 

3.2 

14 

1.1 

48 

3.7 

52 

4.0 

55 

4.2 

FEMALES 

Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

18 

1.3 

817 

59.4 

38 

2.8 

18 

1.3 

456 

33.2 

133 

9.7 

51 

3.7 

61 

4.4 

Allorgans 1,136  87.6  1.592 

Source:    Jahresbericht  des  Aerztlichen  Vereins  zu  Frankfurt  am  Main. 


115.8 


Table  116 

Mortality  from  Cancer  in  Colonge 

1891-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1891 

286,336 

237 

82.8 

1906 

438,963 

410 

93.4 

1892 

294,313 

256 

87.0 

1907 

456,524 

426 

93.3 

1893 

302,290 

255 

84.4 

1908 

474,085 

411 

86.7 

1894 

310,267 

261 

84.1 

1909 

491,646 

441 

89.7 

1895 

318,244 

301 

94.6 
86.7 

1910 
1906-1910 

509,207 

474 

93.1 

1891-1895 

1,511,450 

1,310 

2,370,425 

2,162 

91.2 

1896 

327,507 

310 

94.7 

1911 

526,768 

525 

99.7 

1897 

337,700 

298 

88.2 

1912 

544,329 

553 

101.6 

1898 

347,893 

282 

81.1 

1899 

358,086 

340 

94.9 

Source : 

Naturwissenschaft  und  Gesund- 

1900 

368,279 

312 

84.7 

heitswesen 

in  Coin. 

'Festschrift) 

1908. 

1909-1912,   original    data   furnished  by 
the  Statistical  Office  of  Coin. 

1896-1900 

1,739,465 

1,542 

88.6 

1901 

379,081 

356 

93.9 

1902 

390,320 

344 

88.1 

1903 

401,559 

370 

92.1 

1904 

412,798 

379 

91.8 

1905 

424,037 

394 

92.9 
91.8 

1901-1905 

2,007,795 

1,843 

656 


APPENDIX  G 

Table  117 

Mortality  from  Cancer  in  Essen  a/R.,  by  Sex 

1906-1912 


TOTAL 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1906 
1907 
1908 
1909 
1910 

238,590 
242,137 
255,423 
266,617 
289,309 

141 
158 
162 
168 
161 

60.4 
65.3 
63.4 
63.0 
55.6 

06-1910 

1,287,076 

790 

61.4 

1911 
1912 

298,079 
305,024 

185 
180 

62.1 
59.0 

MALES 

FEMALES 

Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1908 

131,926 

59 

44.7 

1908 

123,497 

103 

83.4 

1909 

137,654 

63 

45.8 

1909 

128,963 

105 

81.4 

1910 

149,341 

68 

45.5 

1910 

139,968 

93 

66.4 

1911 

153,839 

81 

52.7 

1911 

144,240 

104 

72.1 

1912 

157,392 

84 

53.4 
48.6 

1912 
1908-1912 

147,632 

96 
501 

65.0 

1908-1912 

730,152 

355 

684,300 

73.2 

Source: 

Statistisches  Jahrbuch  der  Stadt 

Essen. 

Table  118 

Mortality  from  Cancer  in  Munich 

1896-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1896 

415,500 

542 

130.4 

1906 

544,000 

888 

163.2 

1897 

430,000 

632 

147.0 

1907 

554,000 

905 

163.4 

1898 

446,000 

604 

135.4 

1908 

565,000 

977 

172.9 

1899 

466,000 

669 

143.6 

1909 

577,000 

890 

154.2 

1900 

490,000 

598 

122.0 
135.5 

1910 
1906-1910 

590,000 

1,009 

171.0 

1896-1900 

2,247,500 

3,045 

2,830,000 

4,669 

165.0 

1901 

503,000 

707 

140.6 

1911 

604,000 

979 

162.1 

1902 

509,000 

715 

140.5 

1912 

615,000 

1,081 

175.8 

1903 

515,000 

749 

145.4 

1904 

524,000 

798 

152.3 

Source: 

Munchener  Jahresiibersichten. 

1905 

534,000 

812 

152.1 
146.3 

Note. 

Includes  all  kinds  of  tu 

mors. 

1901-1905 

2,585,000 

3,781 

657 


APPENDIX  G 

Table  119 

Mortality  from  Cancer  in  Munich,  by  Sex 

1896-1911 


MALES 

FEMALES 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 

from 

Cancer 

Rate  per 

100,000 

Population 

1896 
1897 
1898 
1899 
1900 

201,767 
209,023 
217,024 

226,989 
238,924 

184 
252 
221 
255 
238 

91.2 
120.6 
101.8 
112.3 

99.6 

105.1 

1896 
1897 
1898 
1899 
1900 

1896-1900 

213,733 
220,977 
228,976 
239,011 
251,076 

358 
380 
383 
414 
360 

1,895 

167.5 
172.0 
167.3 
173.2 
143.4 

1896-1900 

1,093,727 

1,150 

1,153,773 

164.2 

1901 
1902 
1903 
1904 
1905 

243,653 
244,880 
246,067 
248,638 
251,621 

249 
261 
264 
293 
303 

102.2 
106.6 
107.3 
117.8 
120.4 

110.9 

1901 
1902 
1903 
1904 
1905 

1901-1905 

259,347 
264,120 
268,933 
275,362 

282,379 

458 
454 
485 
505 
509 

176.6 
171.9 
180.3 
183.4 
180.3 

1901-1905 

1,234,859 

1,370 

1,350,141 

2,411 

178.6 

1906 
1907 
1908 
1909 
1910 

256,877 
262,153 
267,923 
274,190 
280,899 

356 
340 
382 
353 
395 

138.6 
129.7 
142.6 

128.7 
140.6 

136.1 

1906 
1907 
1908 
1909 
1910 

1906-1910 

287,123 
291,847 
297,077 
302,810 
309,101 

532 
565 
595 
537 
614 

185.3 
193.6 
200.3 
177.3 
198.6 

1906-1910 

1,342,042 

1,826 

1,487,958 

2,843 

191.1 

1911 

288,108 

376 

130.5 

1911 

315,892 

603 

190.9 

Source: 
Note: 

MUnchener   Jahresiibersichten. 
[ncludes  all  kinds  of  tumors. 

Table  120 

Mortality  from  Cancer  in  Munich,  by  Religious  Confession 

according  to  Organs  and  Parts,  Females 

1907-1909 


All  Cases  of 
Carcinoma 

Carcinoma  Mammae 
Number              Per  Cent. 

Carcinoma  Uteri 
Number            Per  Cent. 

Christians 

Jews 

1,326 

102 

120                   9.0 
17                 16.7 

381                 28.7 
7                   6.8 

Population,  1905:    10,056  Jews,  528,927  others. 

Source:     A.  Theilhaber  and  S.  Greischer.     Zur  Aethiologie  des  Carcinoms. 
schrift  fiir  Krebsforschung,  9.  Band. 


In:  Zeit- 


658 


APPENDIX  G 


Table  121 

Table  122 

Mortality  from  Cancer  in  ] 

Dresden 

Mortality  from  Cancer  in 

Leipzig 

1886-19 

12 

Deaths 

Rate  per 

1881-1912 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1886 

249,150 

247 

99.1 

1881 

151,562 

157 

103.6 

1887 

254,950 

257 

100.8 

1882 

155,812 

159 

102.0 

1888 

261,300 

288 

110.2 

1883 

160,064 

159 

99.3 

1889 

267,750 

281 

104.9 

1884 

164,315 

164 

99.8 

1890 

273,900 

329 

120.1 
107.3 

1885 
1881-1885 

168,567 

141 

83.6 

1886-1890 

1,307,050 

1,402 

800,320 

780 

97.5 

1891 

280,550 

344 

122.6 

1886 

172,819 

159 

92.0 

1892 

304,050 

352 

115.8 

1887 

177,071 

177 

100.0 

1893 

312,900 

380 

121.4 

1888 

181,323 

184 

101.5 

1894 

322,050 

377 

117.1 

1889 

211,598 

204 

96.4 

1895 

332,100 

386 

116.2 
118.5 

1890 
1886-1890 

291,374 

268 

92.0 

1891-1895 

1,551,650 

1,839 

1,034,185 

992 

95.9 

1896 

341,400 

382 

111.9 

1891 

362,118 

291 

80.4 

1897 

369,800 

476 

128.7 

1892 

370,683 

335 

90.4 

1898 

380,500 

402 

105.7 

1893 

379,247 

341 

89.9 

1899 

388,400 

468 

120.5 

1894 

387,812 

327 

84.3 

1900 

393,550 

492 

125.0 
118.5 

1895 
1891-1895 

396,377 

362 

91.3 

1896-1900 

1,873,650 

2,220 

1,896,237 

1,656 

87.3 

1901 

400,900 

506 

126.2 

1896 

405,580 

348 

85.8 

1902 

405,600 

537 

132.4 

1897 

416,812 

414 

99.3 

1903 

491,500 

588 

119.6 

1898 

428,044 

388 

90.6 

1904 

501,800 

617 

123.0 

1899 

439,276 

434 

98.8 

1905 

511,050 

606 

118.6 
123.5 

1900 
1896-1900 

450,508 

409 

90.8 

1901-1905 

2,310,850 

2,854 

2,140,220 

1,993 

93.1 

1906 

519,700 

626 

120.5 

1901 

460,880 

437 

94.8 

1907 

527,600 

672 

127.4 

1902 

470,390 

462 

98.2 

■      1908 

535,550 

693 

129.4 

1903 

479,900 

510 

106.3 

1909 

539,850 

692 

128.2 

1904 

489,410 

507 

103.6 

1910 

543,800 

700 

128.7 
126.9 

1905 
1901-1905 

498,920 

499 

100.0 

1906-1910 

2,666,500 

3,383 

2,399,500 

2,415 

100.6 

1911 

551,150 

763 

139.2 

1906 

509,180 

593 

116.5 

191?- 

558,500 

746 

134.9 

1907 

518,682 

591 

113.9 

1908 

528,184 

559 

105.8 

Source: 

Statistisches 

Jahrbuch  flir  die 

1909 

537,686 

502 

93.4 

Stadt  Dres 

>den. 

1910 
1906-1910 

580,743 

552 

95.1 

2,674,475 

2,797 

104.6 

1911 

595,710 

582 

97.7 

1912 

605,755 

622 

102.7 

Source: 

Statistische  Monatsberichte  der 

Stadt  Leipzig. 

Communications    statistiques 

publiees 

par  le  Bu 

reau  Municipal    de    Statistique 

d' Amsterdam,  No.  33. 

659 


APPENDIX  G 


Table  123 

Table  124 

Mortality  from  Cancer  in  Koenigs- 

Mortality  from  Cancer  in  ] 

Vurem- 

berg, 1881 

-1912 

Deaths 

Rate  per 

berg,  1881 

-1912 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

142,067 

77 

54.2 

1881 

101,500 

77 

75.9 

1882 

144,075 

100 

69.4 

1882 

104,510 

95 

90.9 

1883 

146,111 

84 

57.5 

1883 

106,310 

101 

95.0 

1884 

148,176 

102 

68.8 

1884 

108,810 

102 

93.7 

1885 

150,270 

104 

69.2 
63.9 

1885 
1881-1885 

112,760 

120 

106.4 

1881-1885 

730,699 

467 

533,890 

495 

92.7 

1886 

152,342 

125 

82.1 

1886 

116,550 

160 

137.3 

1887 

154,405 

108 

69.9 

1887 

120,360 

122 

101.4 

1888 

157,317 

115 

73.1 

1888 

125,990 

141 

111.9 

1889 

159,832 

104 

65.1 

1889 

133,010 

128 

96.2 

1890 

161,130 

144 

89.4 
75.9 

1890 
1886-1890 

139,640 

144 

103.1 

1886-1890 

785,026 

596 

635,550 

695 

109.4 

1891 

161,473 

129 

79.9 

1891 

145,550 

146 

100.3 

1892 

161,750 

156 

96.4 

1892 

148,370 

141 

95.0 

1893 

163,120 

180 

110.3 

1893 

149,850 

133 

88.8 

1894 

166,326 

199 

119.6 

1894 

153,960 

138 

89.6 

1895 

171,053 

187 

109.3 
103.3 

1895 
1891-1895 

159,530 

193 

121.0 

1891-1895 

823,722 

851 

757,260 

751 

99.2 

1896 

173,510 

194 

111.8 

1896 

166,310 

189 

113.6 

1897 

177,189 

171 

96.5 

1897 

175,580 

176 

100.2 

1898 

181,249 

194 

107.0 

1898 

192,120 

193 

100.5 

1899 

185,014 

208 

112.4 

1899 

240,640 

256 

106.4 

1900 

187,743 

175 

93.2 
104.1 

1900 
1896-1900 

254,180 

232 

91.3 

1896-1900 

904,705 

942 

1,028,830 

1,046 

101.7 

1901 

189,818 

208 

109.6 

1901 

265,180 

245 

92.4 

1902 

191,642 

198 

103.3 

1902 

267,730 

261 

97.5 

1903 

193,511 

213 

110.1 

1903 

272,170 

270 

99.2 

1904 

195,834 

271 

138.4 

1904 

280,000 

290 

103.6 

1905 

198,874 

270 

135.8 
119.6 

1905 
1901-1905 

291,200 

299 

102.7 

1901-1905 

969,679 

1,160 

1,370,280 

1,365 

99.2 

1906 

226,265 

311 

137.4 

1906 

298,946 

300 

100.4 

1907 

231,787 

322 

138.9 

1907 

306,691 

308 

100.4 

1908 

236,292 

288 

121.9 

1908 

314,436 

315 

100.2 

1909 

241,120 

284 

117.8 

1909 

322,181 

322 

99.9 

1910 

243,982 

313 

128.3 
128.7 

1910 
1906-1910 

329,926 

346 

104.9 

1906-1910 

1,179,446 

1,518 

1,572,180 

1,591 

101.2 

1911 

249,067 

300 

120.4 

1911 

337,671 

356 

105.4 

1912 

255,684 

302 

118.1 

1912 

345,416 

382 

110.6 

Source:  Communications  statistiques 
publiees  par  le  Bureau  Municipal  de  Statis- 
tique  d' Amsterdam,  No.  33. 

Statistisches  Jahrbuch  fiir  Kiinigsberg, 
1908-1912. 


Source:  Communications  statistiques 
publiees  par  le  Bureau  Municipal  de  Statis- 
tique  d' Amsterdam,  No.  33. 

Bericht  uber  die  Gesundtheitsverhalt- 
nisse  und  Gesundheitsanstalten  in  Niirn- 
berg. 


660 


APPENDIX  G 


Table  125 

Table  126 

Mortality  from  Cancer  in  Holland 

Mortality  from  Cancer  in  Holland 

1881-1913 

Rate  per 

by  Sex,  1901-1913 

Deaths 

MALES 

Year 

Population 

from 

100,000 

Cancer 

Population 

Deaths 

Rate  per 

1881 

4,087,334 

2,353 

57.6 

Year 

Population 

from 
Cancer 

100,000 
Population 

1882 

4,143,524 

2,421 

58.4 

1901 

2,577,318 

2,367 

91.8 

1883 

4,199,018 

2,436 

58.0 

1902 

2,614,568 

2,573 

98.4 

1884 

4,251,669 

2,621 

61.6 

1903 

2,651,817 

2,668 

100.6 

1885 

4,307,142 

2,841 

66.0 

1904 

2,689,067 

2,642 

98.2 

1905 

2,726,316 

2,816 

103.3 

1881-1885 

20,988,687 

12,672 

60.4 

1886 

4,363,434 

2,925 

67.0 

1901-1905 

13,259,086 

13,066 

98.6 

1887 
1888 
1889 
1890 

4,420,864 
4,478,401 
4,527,264 
4,537,990 

2,887 
3,111 
3,411 
3,332 

65.3 
69.5 
75.3 
73.4 

70.2 
79.4 

1906 
1907 
1908 
1909 
1910 

1906-1910 

2,769,160 
2,806,485 
2,843,810 
2,881,135 
2,918,460 

2,880 
2,830 
2,940 
2,997 
3,117 

104.0 
100.8 
103.4 
104.0 

1886-1890 

22,327,953 
4,593,155 

15,666 
3,648 

106.8 

1891 

14,219,050 

14,764 

103.8 

1892 

4,645,660 

3,712 

79.9 

1893 

4,701,243 

3,798 

80.8 

1911 

2,955,785 

3,276 

110.8 

1894 

4,764,279 

3,859 

81.0 

1912 

2,993,110 

3,230 

107.9 

1895 

4,827,549 

4,122 

85.4 

1913 

3,050,933         3,324 
FEMALES 

109.0 

1891-1895 

23,531,886 

19,139 

81.3 

1901 

2,639,925 

2,527 

95.7 

1896 

4,894,055 

4,329 

88.5 

1902 

2,678,079 

2,467 

92.1 

1897 

4,966,431 

4,487 

90.3 

1903 

2,716,234 

2,663 

98.0 

1898 

5,039,418 

4,685 

93.0 

1904 

2,754,388 

2,714 

98.5 

1899 

5,107,098 

4,900 

95.9 

1905 

2,792,543 

2,802 

100.3 

1900 

5,159,347 

4,733 

91.7 

1901-1905 

13,581,169 

13,173 

97.0 

1896-1900 

25,166,349 

23,134 

91.9 

1901 
1902 
1903 
1904 
1905 

5,217,243 
5,292,647 
5,368,051 
5,443,455 
5,518,859 

4,894 
5,040 
5,331 
5,356 
5,618 

93.8 
95.2 
99.3 
98.4 
101.8 

97.8 

1906 
1907 
1908 
1909 
1910 

1906-1910 

2,825,103 
2,863,182 
2,901,261 
2,939,340 

2,977,419 

2,793 
2,986 
3,007 
3,015 
3,162 

98.9 
104.3 
103.6 
102.6 
106.2 

14,506,305 

14,963 

1901-1905 

26,840,255 

26,239 

103.1 

1906 

5,594,263 

5,673 

101.4 

1911 

3,015,498 

3,225 

106.9 

1907 

5,669,667 

5,816 

102.6 

1912 

3,053,577 

3,406 

111.5 

1908 

5,745,071 

5,947 

103.5 

1913 

3,112,567 

3,423 

110.0 

1909 

5,820,475 

6,012 

103.3 

1910 

5,895,879 

6,279 

106.5 

Source: 

Jaarcijfers  voor  het  Koninkrijk 

der  Nederlanden, 

1906-1910 

28,725,355 

29,727 

103.5 

Bijdragen  tot  de  Statistiek  van  Neder- 

land:    Statistiek  van 

de  Sterfte 

naar  den 

1911 
1912 

5,971,283 
6,046,687 

6,501 
6,636 

108.9 
109.7 

Leeftijd    e 
Dood. 

n   naar   de 

Oorzaken 

van   den 

1913 

6,163,500 

6,747 

109.5 

Source : 

Jaarcijfers 

voor  het  Koninkrijk 

der  Nederlanden. 

Bijdrag 

en  tot  de  Statistiek  van  Neder- 

land:     Statistiek  van 

de  Sterfte 

naar  den 

Leeftijd    en    naar    de  Oorzaken 

van    den 

Dood. 

661 


APPENDIX  G 

Table  127 
Mortality  from  Cancer  in  Holland,  by  Organs  and  Parts,  according  to  Sex 

1906-1912 


MALES 

Deaths  Rate  per 

Organ  or  Part                                                 from  100,000 

Cancer  Population 

Buccal  cavity 761  5.26 

Stomach  and  liver : 10,424  71.99 

Peritoneum,  intestines  and  rectum 1,680  11.60 

Female  generative  organs 

Breast 11  0.08 

Skin 250  1.73 

Other  or  not  specified  organs 2,317  16.00 


All  organs 15,443 

Source:     Bijdragen  tot  de  Statistiek  vanNederland 
den  Leeftijd  en  naar  de  Oorzaken  van  den  Dood. 
Note:     Includes  only  carcinoma. 


FEMALES 

Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

206 

1.39 

8,067 

54.61 

2,035 

13.78 

1,929 

13.06 

1,470 

9.95 

186 

1.26 

1,700 

11.51 

106.65  15,593         105.55 

Statistiek  van  de  Sterf  te  naar 


Table  128 

Mortality  from  Cancer  in  Amsterdam 

1881-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

338,047 

244 

72.2 

1901 

530,718 

512 

96.5 

1882 

350,201 

254 

72.5 

1902 

538,815 

543 

100.8 

1883 

361,326 

246 

68.1 

1903 

546,534 

578 

105.8 

1884 

366,660 

276 

75.3 

1904 

551,415 

599 

108.6 

1885 

372,325 

284 

76.3 
72.9 

1905 
1901-1905 

557,614 

623 

111.7 

1881-1885 

1,788,559 

1,304 

2,725,096 

2,855 

104.8 

1886 

378,686 

290 

76.6 

1906 

564,186 

626 

111.0 

1887 

390,016 

282 

72.3 

1907 

565,654 

596 

105.4 

1888 

399,424 

300 

75.1 

1908 

565,589 

662 

117.0 

1889 

408,061 

385 

94.3 

1909 

566,131 

637 

112.5 

1890 

417,539 

343 

82.1 
80.3 

1910 
1906-1910 

573,983 

690 

120.2 

1886-1890 

1,993,726 

1,600 

2,835,543 

3,211 

113.2 

1891 

426,914 

372 

87.1 

1911 

580,960 

664 

114.3 

1892 

437,892 

399 

91.1 

1912 

588,000 

702 

119.4 

1893 

446,657 

390 

87.3 

1913 

595,000 

683 

114.8 

1894 

450,189 

394 

87.5 

1895 

456,324 

389 

85.2 

Source: 

Statistisch 

Jaarboek      der 

Gemeente  Amsterdam. 
Jaarcijfers    voor    het 

1891-1895 

2,217,976 

1,944 

87.6 

Koninkrijk     der 

Nederlanden.     1913. 

1896 

494,189 

425 

86.0 

1897 

503,285 

472 

93.8 

1898 

512,953 

510 

99.4 

1899 

510,853 

540 

105.7 

1900 

520,602 

507 

97.4 
96.5 

1896-1900 

2,541,882 

2,454 

662 


APPENDIX  G 

Table  129 

Mortality  from  Cancer  in  Amsterdam,  by  Sex 

1901-1912 


MALES 

FEMALES 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1901 

251,820 

219 

87.0 

1901 

278,898 

293 

105.1 

1902 

256,160 

284 

110.9 

1902 

282,655 

259 

91.6 

1903 

260,590 

263 

100.9 

1903 

285,944 

315 

110.2 

1904 

263,151 

285 

108.3 

1904 

288,264 

314 

108.9 

1905 

266,381 

312 

117.1 
105.0 

1905 
1901-1905 

291,233 

311 

106.8 

1901-1905 

1,298,102 

1,363 

1,426,994 

1,492 

104.6 

1906 

269,850 

310 

114.9 

1906 

294,336 

316 

107.4 

1907 

270,344 

284 

105.1 

1907 

295,310 

312 

105.7 

1908 

270,230 

317 

117.3 

1908 

295,359 

345 

116.8 

1909 

269,723 

301 

111.6 

1909 

296,408 

336 

113.4 

1910 

273,976 

316 

115.3 
112.8 

1910 
1906-1910 

300,007 

374 

124.7 

1906-1910 

1,354,123 

1,528 

1,481,420 

1,683 

113.6 

1911 
1912 

277,863 
281,240 

311 
350 

111.9 
124.4 

1911 
1912 

303,097 
306,760 

353 
352 

116.5 
114.7 

Source: 

Statistisch 

Jaarboek      der 

Gemeente  Amsterdam. 

Table  130 
Mortality  from  Cancer  in  Amsterdam,  by  Organs  and  Parts,  Males 

1862-1902 


Number  or 

Deaths 

Percentage  of 

All  Deaths 

FROM  CaHCINOMA 

FROM  Carcinoma 

186^2- 

1872- 

1886- 

1897- 

1862- 

1872- 

1886- 

1897- 

Organ  or  Part 

1867 

1877 

1891 

1902 

1867 

1877 

1891 

1902 

Tongue 

10 

20 

24 

37 

2.9 

4.4 

2.9 

2.8 

Pharynx 

2 

1 

7 

16 

0.6 

0.2 

0.8 

1.2 

Larynx 

1 

4 

13 

35 

0.3 

0.9 

1.6 

2.7 

(Esophagus 

16 

24 

92 

159 

4.6 

5.3 

11.2 

12.2 

Stomach 

212 

246 

416 

613 

61.3 

53.8 

50.7 

46.9 

Intestines 

9 

11 

26 

71 

2.6 

2.4 

3.2 

5.4 

Rectum 

6 

9 

25 

66 

1.7 

2.0 

3.0 

5.0 

Liver 

39 

69 

91 

133 

11.3 

15.1 

11.1 

10.2 

Peritoneum 

3 

2 

4 

8 

0.9 

0.4 

0.5 

0.6 

Vesica  urinaria 

2 

9 

22 

28 

0.6 

2.0 

2.7 

2.1 

Breast 

1 

2 

0.0 

0.0 

0.1 

0.2 

Bones 

4 

12 

5 

17 

1.2 

2.6 

0.6 

1.3 

Skin 

4 

5 

12 

19 

1.2 

1.1 

1.5 

1.5 

Other  organs 

9 

19 

59 

68 

2.6 

4.2 

7.2 

5.2 

Not  specified 

29 

26 

23 

36 

8.2 

5.6 

2.9 

2.7 

All  carcinoma 

346 

457 

820 

1,308 

100.0 

100.0 

100.0 

100.0 

Source:     Communications  Statistiques  publiees  par  le  Bureau  Municipal  de  Statis- 
tique  d'  Amsterdam,  No.  26.     Amsterdam,  1911. 


663 


APPENDIX  G 

Table  131 

Mortality  from  Cancer  in  Amsterdam,  by  Organs  and  Parts,  Females 

1862-1902 

Number  of  Deaths  Pebcentage  of  All  Deaths 

FBOII  CaBCLN'OMA                            '  FBOM  CaBCISOMA 

1862-   1872-   1886-   1897-  186-2-   1872-   1886-   1897- 

OrganorPart             1867    1877    1891    1902  1867    1877    1891  1902 

Tongue 3            3  0.0         0.0         0.3  0.2 

Pharj-nx 1           ..             1            2  0.2         0.0         0.1  0.1 

LarjTix 3            1             1  0.0         0.5         0.1  0.1 

(Esophagus 2            3          12          31  0.4         0.5         1.1  2.0 

Stomach 133        197        305        464  25.7       30.4       33.8  29.2 

Intestines 9          15          19          93  1.7         2.3         1.8  5.9 

Rectum 6            6          23          54  1.2         0.9         2.1  3.4 

Liver 65          98        156        242  12.6       15.1       14.5  15.2 

Peritoneum 4            4          11          28  0.8         0.6         1.0  1.8 

Vesica  urinaria 2          16          24  0.0         0.3         1.5  1.5 

Breast 77          83        123        158  14.9       12.8       11.4  9.9 

Ovaries 1            3          10          28  0.2         0.5         0.9  1.8 

Uterus 156        174        240        317  30.2       26.8       22.2  20.0 

Vagina 7            3            5            7  1.4         0.5         0.5  0.4 

Vulvae 1            2            9  0.0         0.2        0.2  0.6 

Bones 2           5            4          11  0.4         0.8         0.4  0.7 

Skin 7            7            6          10  1.4         1.1         0.6  0.6 

Other  organs 9          14          33          44  1.7         2.1         3.1  2.8 

Not  specified 38          31          49          62     '  7.2        4.6        4.4  3.8 

All  carcmoma 517        649     1,079     1,588     ;     100.0     100.0     100.0  100.0 

Source:     Comnnmications  Statistiques  publiees  par  le  Bureau  Municipal  de  Statis- 
tique  d'Amsterdam,  No.  26.     Amsterdam,  1911. 

Table  132 
Mortality  from  Cancer  in  Amsterdam,  by  Organs  and  Parts 

according  to  Age,  Males 
1897-1902 

Number  of  Deaths  fbou  Carcinoma 

34  and  75  and 

Organ  or  Part                         Under          35-44           45-54            55-64  65-74           Over  Total 

Buccal  ca\nty  and  pharnj-x  ....                1             13             21  15             10  60 

(Esophagus 1               9             34             46  54             15  159 

Stomach 5             27             98           224  187             72  613 

Intestines  and  rectum 5             10             20             43  45             14  137 

Liver 3               3             26             48  35             18  133 

Otherorgans 6             15             43             60  56             26  206 

-\11  carcinoma 20             65           234           442  392           155  1,308 

Pehcentage  of  Aix  Ages 

Buccal  ca^•ity  and  pharjmx .  .    0.0            1.7          21.7          35.0  25.0          16.6  100.0 

(Esophagus 0.6            5.7          21.4          28.9  34.0            9.4  100.0 

Stomach 0.8            4.4          16.0          36.5  30.5          11.8  100.0 

Intestines  and  rectum 3.6           7.3          14. G          31.5  32.8          10.2  100.0 

Liver 2.3            2.3          19.5          36.1  26.3          13.5  100.0 

Otherorgans 2.9            7.3          20.9          29.1  27.2          12.6  100.0 

All  carcinoma 1.5           5.0          17.9         33.8  30.0          11.8  100.0 

Source:     Communicatirns  Statistiques  publiees  par  le  Bureau  Municipal  de  Statis- 
tique  d'Amsterdam,  No.  26.     Amsterdam,  1911. 


6G4 


APPENDIX  G 

Table  133 

Mortality  from  Cancer  in  Amsterdam,  by  Organs  and  Parts 
according  to  Age,  Females 

1897-1902 

Number  of  Deaths  from  Carcinoma 

34  and  75  and 

Organ  or  Part                        Under           35-44           45-54            55-04  e5-74  Over  Total 

Buccal  cavity  and  pharynx  . .        1               2               1               1  1  1  7 

(Esophagus 2              ..                8  12  9  31 

Stomach 3             24             57           128  152  100  464 

Intestines  and  rectum 4               7             26             48  43  20  148 

Liver 2             13             21             71  83  52  242 

Breast 4             17             42             41  38  16  158 

Uterus 21             45             95             90  51  15  317 

Other  organs 4             20             45             63  49  40  221 

All  carcinoma 39           130           287          450  429  253  1,588 

Percentage  of  All  Ages 

Buccal  cavity  and  pharynx.  .  14.3          28.5          14.3          14.3  14.3  14.3  100.0 

(Esophagus 0.0            6.5            0.0          25.8  38.7  29.0  100.0 

Stomach 0.6            5.2          12.3          27.6  32.8  21.5  100.0 

Intestines  and  rectum 2.7           4.7          17.6         32.4  29.1  13.5  100.0 

Liver 0.8            5.4            8.7          29.3  34.3  21.5  100.0 

Breast 2.5          10.8          26.6         25.9  24.1  10.1  100.0 

Uterus 6.6          14.2          30.0          28.4  16.1  4.7  100.0 

Otherorgans 1.8            9.0          20.4          28.5  22.2  18.1  100.0 

All  carcinoma 2.5           8.2          18.1          28.3  27.0  15.9  100.0 

Source:     Communications  Statistiques  publiees  par  le  Bureau  Municipal  de  Statis- 
tique  d'Amsterdam,  No.  26.     Amsterdam,  1911. 


Table  134 

Mortality  from  Cancer  in  The  Hague 

1901-1913 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Cancer 

Population 

1901 

215,120 

209 

97.2 

1902 

220,253 

229 

104.0 

1903 

226,140 

255 

112.8 

1904 

232,132 

244 

105.1 

1905 

238,257 

239 

100.3 

1901-1905 

1,131,902 

1,176 

103.9 

1906 

245,525 

263 

107.1 

1907 

251,749 

278 

110.4 

1908 

256,758 

272 

105.9 

1909 

264,561 

271 

102.4 

1910 

275,312 

318 

115.5 

1906-1910 

1,293,905 

1,402 

108.4 

1911 

284,547 

305 

107.2 

1912 

294,540 

324 

110.0 

1913 

298,272 

373 

125.1 

Source:  Statistiek  van  de  Sterfte  naar 
den  Leeftijd  en  naar  de  Oorzaken  van  den 
Dood  (Statistiek  van  Nederland). 


665 


APPENDIX  G 

Table  135 
Mortality  from  Cancer  in  The  Hague,  by  Sex,  1901-1912 


MALES 

FEMALES 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1901 

97,243 

81 

83.3 

1901 

117,877 

128 

108.6 

1902 

99,596 

95 

95.4 

1902 

120,657 

134 

111.1 

1903 

102,384 

118 

115.3 

1903 

123,756 

137 

110.7 

1904 

105,257 

115 

109.3 

1904 

126,875 

129 

101.7 

1905 

108,381 

104 

96.0 
100.0 

19,05 
1901-1905 

129,876 

135 

103.9 

1901-1905 

512,861 

613 

619,041 

663 

107.1 

1906 

112,065 

118 

105.3 

1906 

133,460 

145 

108.6 

1907 

114,912 

126 

109.6 

1907 

136,837 

152 

111.1 

1908 

117,095 

116 

99.1 

1908 

139,663 

156 

111.7 

1909 

120,619 

115 

95.3 

1909 

143,942 

156 

108.4 

1910 

125,398 

133 

106.1 
103.1 

1910 
1906-1910 

149,914 

185 

123.4 

1906-1910 

590,089 

608 

703,816 

794 

112.8 

1911 

129,505 

152 

117.4 

1911 

155,042 

153 

98.7 

1912 

133,948 

139 

103.8 

1912 

160,592 

185 

115.2 

Source: 

Statistiek 

van  de  Sterfte  naar 

den  Leeftijd  en  naar  de  Oorzaken 
Dood  (Statistiek  van  Nederland). 

van  den 

Table  136 

Mortality 

from  Cancer  in  Rotterdam 

1901- 

1913 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1901 
1902 
1903 
1904 
1905 

341,051 
348,474 
357,474 
370,390 
379,017 

272 
275 
336 
304 
323 

79.8 
78.9 
94.0 
82.1 
85.2 

1901-1905 

1,796,406 

1,510 

84.1 

1906 
1907 
1908 
1909 
1910 

390,364 
403,355 
411,635 

417,780 
426,888 

370 
382 
348 
344 
394 

94.8 
94.7 

84.5 
82.3 
92.3 

1906-1910 

2,050,022 

1,838 

89.7 

1911 
1912 
1913 

436,018 
445,137 
453,128 

462 
432 
433 

106.0 
97.0 
95.6 

Source:  Statistiek  van  de  Sterfte  naar 
den  Leeftijd  en  naar  de  Oorzaken  van  den 
Dood  (Statistiek  van  Nederland). 


666 


APPENDIX  G 

Table  137 

Mortality  from  Cancer  in  Rotterdam,  by  Sex 

1901-1912 


MALES 

FEMALES 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1901 

163,650 

115 

70.3 

1901 

177,401 

157 

88.5 

1902 

167,542 

129 

77.0 

1902 

180,932 

146 

80.7 

1903 

172,244 

.    151 

87.7 

1903 

185,230 

185 

99.9 

1904 

178,680 

131 

73.3 

1904 

191,710 

173 

90.2 

1905 

183,045 

152 

83.0 

78.4 

1905 
1901-1905 

195,972 

171 

87.3 

1901-1905 

865,161 

678 

931,245 

832 

89.3 

1906 

189,036 

181 

95.7 

1906 

201,328 

189 

93.9 

1907 

195,678 

173 

88.4 

1907 

207,677 

209 

100.6 

1908 

199,754 

172 

86.1 

1908 

211,881 

176 

83.1 

1909 

202,627 

152 

75.0 

1909 

215,153 

192 

89.2 

1910 

207,716 

185 

89.1 
86.8 

1910 
1906-1910 

219,172 

209 

95.4 

1906-1910 

994,811 

863 

1,055,211 

975 

92.4 

1911 

212,561 

203 

95.5 

1911 

223,457 

259 

115.9 

1912 

217,528 

195 

89.6 

1912 

227,609 

237 

104.1 

Source : 

Statistiek 

van  de  Sterfte  naar 

den  Leeftijd  en  naar  de  Oorzaken 
Dood  (Statistiek  van  Nederland). 

van  den 

Table  138 

Table  139 

Mortality  from  Cancer  in 

Belgium 

Mortality  from  Cancer  in 

Belgium 

1903- 

1912 

Rate  per 

Mai 
1903- 

es 
1912 

Deaths 

Year 

Population 

from 

100,000 

Deaths 

Rate  per 

Cancer 

Population 

Year 

Population 

from 

100,000 

1903 

6,876,303 

4,084 

59.4 

Cancer 

Population 

1904 

6,949,300' 

3,969 

57.1 

1903 

3,417,523 

1,849 

54.1 

1905 

7,022,297 

4,203 

59.9 

1904 

3,453,802 

1,771 

51.3 

1905 

3,490,082 

1,825 

52.3 

1906 

7,095,294 

4,232 

59.6 

1907 

7,168,291 

4,396 

61.3 

1906 

3,519,266 

1,892 

53.8 

1908 

7,241,288 

4,713 

65.1 

1907 

3,555,472 

1,970 

55.4 

1909 

7,314,285 

4,786 

65.4 

1908 

3,591,679 

2,068 

57.6 

1910 

7,387,282 

4,699 

63.6 

1909 
1910 

3,627,885 
3,664,092 

2,189 
2,083 

60.3 
56.8 

1906-1910 

36,206,440 

22,826 

63.0 

1906-1910 

17,958,394 

10,202 

56.8 

1911 

7,460,279 

5,140 

68.9 

1912 

7,533,276 

5,374 

71.3 

1911 

3,700,298 

2,309 

62.4 

1912 

3,736,505 

2,476 

66.3 

Source : 

Annuaire  Statistique  de  la  Bel- 

gique. 

Source: 

Annuaire  Statistique  de  la  Bel- 

gique. 

667 


APPENDIX  G 


Table  140 

Table  141 

Mortality  from  Cancer  in 

Belgium 

Mortality  from  Cancer  in 

Liege 

Females 

1903- 

1912 

1903- 

912 

Ti^iatVic 

Deaths 

Rate  per 

Year 

Population 

from 

iv3.tc  per 
100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1903 

166,280 

131 

78.8 

1903 

3,458,780 

2,235 

64.6 

1904 

166,455 

143 

85.9 

1904 

3,495,498 

2,198 

62.9 

1905 

166,630 

163 

97.8 

1905 

3,532,215 

2,378 

67.3 

1906 

166,805 

120 

71.9 

1906 

3,576,028 

2,340 

65.4 

1907 

166,980 

160 

95.8 

1907 

3,612,819 

2,426 

67.1 

1908 

167,155 

187 

111.9 

1908 

3,649,609 

2,645 

72.5 

1909 

167,330 

153 

91.4 

1909 

3,686,400 

2,597 

70.4 

1910 

167,505 

174 

103.9 

1910 

3,723,190 

2,616 

70.3 

1906-1910 

835,775 

794 

95.0 

1906-1910 

18,248,046 

12,624 

69.2 

1911 

167,676 

187 

111.5 

1911 

3,759,981 

2,831 

75.3 

1912 

167,851 

177 

105.5 

1912 

3,796,771 

2,898 

76.3 

Source: 

Rapport   Annuel    des 

Servnces 

Source: 

Annuaire  Statistique 

de  la  Bel- 

de  L'Etat  Civil  et  de  la  Population. 

gique. 

Table  142 

Mortality  from  Cancer  in  Liege,  by  Sex 

1905-1912 


MALES 

FEjNIALES 

Year 
1905 

Population 
79,566 

Deaths 
from 
Cancer 

67 

Rate  per 

100,000 

Population 

84.2 

Year 
1905 

Population 
87,064 

Deaths 
from 
Cancer 

96 

Rate  per 

100,000 

Population 

110.3 

1906 
1907 
1908 
1909 
1910 

79,499 

79,432 
79,365 
79,298 
79,230 

54 
69 

72 
72 
79 

67.9 
86.9 
90.7 
90.8 
99.7 

87.2 

1906 
1907 
1908 
1909 
1910 

1906-1910 

87,306 
87,548 
87,790 
88,032 
88,275 

66 
91 
115 
81 
95 

75.6 
103.9 
131.0 

92.0 
107.6 

1906-1910 

396,824 

346 

438,951 

448 

102.1 

1911 
1912 

79,177 
79,108 

81 

77 

102.3 
97.3 

1911 
1912 

88,499 
88,743 

106 
100 

119.8 
112.7 

Source:     Rapport  Annuel    des   Services 
de  L'Etat  Civil  et  de  la  Population. 

668 


APPENDIX  G 

Table  143 

Mortality  from  Cancer  in  Antwerp 

1896-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1896 

260,568 

124 

47.6 

1906 

295,941 

205 

69.3 

1897 

264,198 

149 

56.4 

1907 

299,416 

218 

72.8 

1898 

267,829 

150 

56.0 

1908 

302,891 

262 

86.5 

1899 

271.460 

155 

57.1 

1909 

306,366 

300 

97.9 

1900 

275,091 

156 

56.7 
54.8 

1910 
1906-1910 

309,841 

261 

84.2 

1896-1900 

1,339,146 

734 

1,514,455 

1,246 

82.3 

1901 

278,566 

173 

62.1 

1911 

313,316 

260 

83.0 

1902 

282,041 

180 

63.8 

1912 

322,275 

293 

90.9 

1903 

285,516 

202 

70.7 

1904 

288,991 

203 

70.2 

Source : 

Stad  Antwerpen. 

Gezond- 

1905 

292,466 

213 

72.8 
68.0 

heidsbureel 

:  Volksbeschrijvende 

Statistiek. 

1901-1905 

1,427,580 

971 

Table  144 

Mortality  from  Cancer  in  Brussels 

1901-1912 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1901 

187,145 

165 

88.2 

1906 

182,110 

168 

92.3 

1902 

186,138 

151 

81.1 

1907 

181,103 

205 

113.2 

1903 

185,131 

160 

86.4 

1908 

180,096 

187 

103.8 

1904 

184,124 

183 

99.4 

1909 

179,090 

185 

103.3 

1905 

183,117 

172 

93.9 
89.8 

1910 
1906-1910 

178,084 

181 

101.6 

1901-1905 

925,655 

831 

900,483 

926 

102.8 

1911 

177,078 

198 

111.8 

1912 

176,947 

188 

106.2 

Source: 
Annual. 
Note: 

Villa  de  Bruxelles.       Rapport 
Demographie  Statistique. 
Without  suburbs. 

669 


APPENDIX  G 

Table  145 

Mortality  from  Cancer  in  France 

1892-1911 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year               Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1892 

12,223,548 

10,761 

88.0 

1906          39,282,000 

27,306 

69.5 

1893 

12,223,548 

11,442 

93.6 

1907          39,279,000 

29,284 

74.6 

1894 

12,223,548 

11,607 

95.0 

1908          39,368,000 

30,124 

76.5 

1895 

12,223,548 

11,955 

97.8 

1909  39,421,000 

1910  39,528,000 

30,645 
31,303 

77.7 
79.2 

1892-1895 

48,894,192 

45,765 

93.6 

1906-1910  196,878,000 

148,662 

75.5 

1896 

12,869,412 

12,212 

94.9 

1897 

12,869,412 

12,631 

98.1 

1911         39,602,000 

31,768 

80.2 

1898 

12,869,412 

12,789 

99.4 

1899 

12,869,412 

13,161 

102.3 

Source :    Annual  Report  of  the  Registrar- 

1900 

12,869,412 

13,392 

104.1 

General  of  Births,  Deaths  and  Marriages 

in  England  and  Wales, 

1911. 

1896-1900 

64,347,060 

64,185 

99.7 

Note:  Previous  to  1906  the  data  are  for 

1901 

13,771,440 

12,385 

89.9 

cities  with  more  than 
only. 

5,000  inhabitants 

1902 

13,771,440 

12,463 

90.5 

1903 

13,771,440 

12,912 

93.8 

1904 

13,771,440 

13,312 

96.7 

1905 

13,771,440 

13,793 

100.2 
94.2 

1901-1905 

68,857,200 

64,865 

Table  146 

Mortality  from  Cancer  in  Cities  of  France,  according  to  Size 

1906-1910 


Size  of  Cities  Population 

Paris 13,862,165 

100,000-518,000  population 13,713,307 

30,000-100,000  population 14,265,701 

20,000-30,000  population 7,090,747 

10,000-20,000  population 10,666,695 

5,000-10,000  population 12,376,876 

Under  5,000  population 124,902,507 

Total,  all  France 196,877,998 

Source:     Annuaire  Statistique  de  la  France. 


Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

15,385 

111.0 

16,313 

119.0 

16,319 

114.4 

7,066 

99.7 

9,591 

89.9 

8,969 

72.5 

75,019 

60.1 

148,662 


75.5 


670 


APPENDIX  G 


Table  147 
Mortality  from  Cancer  in 
1881-1913 

Paris 

Rate  per 

100,000 

Population 

97.2 
97.7 
94.0 
94.9 
98.2 

96.4 

100.4 
97.7 
98.9 
98.8 
97.1 

98.6 

99.5 

94.9 

99.2 

102.4 

102.6 

99.8 

105.2 
107.0 
107.1 
105.2 
104.2 

105.7 

108.9 
105.9 
109.3 
107.1 
114.1 

109.1 

114.9 
111.1 
111.1 
109.0 
108.9 

111.0 

112.6 
112.4 
110.9 

le     de     la 

Mortal 

Year 

1893 
1894 
1895 

1896 
1897 
1898 
1899 
1900 

1896-1900 

1901 
1902 
1903 
1904 
1905 

1901-1905 

1906 
1907 
1908 
1909 
1910 

1906-1910 

1911 
1912 
1913 

Source: 
Yille  de  Pa 

Table  1 

ity  from  d 

Males,  189 

48 

mcer  in 
3-1913 

Deaths 
from 
Cancer 

851 
892 
963 

982 
1,044 
1,059 
1,066 
1,066 

Paris 

Year 
1881 

1882 
1883 
1884 
1885 

Population 

2,239,928 
2,244,131 
2,248,334 
2,252,537 
2,256,741 

Deaths 
from 
Cancer 

2,178 
2,193 
2,114 
2,137 
2,215 

Population 

1,184,483 
1,189,883 
1,195,491 

1,200,810 
1,212,255 

1,223,377 
1,234,689 
1,245,671 

Rate  per 

100,000 

Population 

71.8 
75.0 
80.6 

81.8 
86  1 

1881-1885 

1886 
1887 
1888 
1889 
1890 

11,241,671 

2,260,945 
2,293,697 
2,326,449 
2,359,201 
2,391,953 

10,837 

2,269 
2,240 
2,301 
2,332 
2,323 

86.6 
86.3 
85.6 

6,116,802 

1,256,848 
1,260,316 
1,263,762 
1,267,185 
1,270,857 

5,217 

1,081 
1,054 
1,132 
1,093 
1,184 

85.3 

86.0 
83  6 

1886-1890 

1891 
1892 
1893 
1894 
1895 

11,632,245 

2,424,705 
2,442,089 
2,459,474 
2,476,859 
2,494,244 

11,465 

2,413 
2,318 
2,440 
2,537 
2,560 

89.6 
86.3 
93.2 

6,318,968 

1,274,510 
1,286,967 
1,299,439 
1,311,926 
1,324,428 

5,544 

1,189 
1,110 
1,177 
1,199 
1,189 

87.7 

93.3 

86  2 

1891-1895 

1896 
1897 
1898 
1899 
1900 

12,297,371 

2,511,629 
2,541,415 
2,571,201 
2,600,987 
2,630,773 

12,268 

2,642 
2,719 
2,753 
2,735 
2,740 

90.6 
91.4 
89.8 

6,497,270 

1,337,121 
1,348,879 
1,360,666 

Annuaire 
ris. 

5,864 

1,297 
1,270 
1,327 

Statistic 

90.3 

97.0 

94  2 

1896-1900 

1901 
1902 
1903 
1904 
1905 

12,856,005 

2,660,559 
2,672,993 
2,685,427 
2,697,861 
2,710,295 

13,589 

2,898 
2,832 
2,936 
2,890 
3,093 

97.5 
jue    de  la 

1901-1905 

1906 
1907 
1908 
1909 
1910 

13,427,135 

2,722,731 

2,747,582 
2,772,433 
2,797,284 
2,822,135 

14,649 

3,129 
3,053 
3,080 
3,050 
3,073 

1906-1910  13,862,165 

1911  2,847,229 

1912  2,872,400 

1913  2,897,500 

Source :     Annuaire 
Ville  de  Paris. 

15,385 

3,205 
3,230 
3,212 

Statistiqi. 

44 


671 


APPENDIX  G 


Table  149 

Mortality  from  Cancer  in  Paris,  Females 

1893-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1893 

1,274,991 

1,589 

124.6 

1906 

1,448,221 

1,940 

134.0 

■    1894 

1,286,976 

1,645 

127.8 

1907 

1,460,615 

1,943 

133.0 

1895 

1,298,753 

1,597 

123.0 

1908 

1,472,994 

1,903 

129.2 

1909 

1,485,358 

1,851 

124.6 

1896 
1897 

1,310,819 
1,329,160 

1,660 
1,675 

126.6 
126.0 

1910 

1,497,707 

l,88t 

125.8 

1898 

1,347,824 

1,694 

125.7 

1906-1910 

7,364,895 

9,521 

129.3 

1899 

1,366,298 

1,669 

122.2 

1900 

1,385,102 

1,674 

120.9 

1911 

1,510,108 

1,908 

126.3 

1912 
1913 

1,523,521 
1,536,834 

1,960 
1,885 

1  28  fi 

1896-1900 

6,739,203 

8,372 

124.2 

122.7 

1901 

1,403,711 

1,817 

129.4 

Source : 

Annuaire 

Statistique    de  la 

1902 

1,412,677 

1,778 

125.9 

Ville  de  Paris. 

1903 

1,421,665 

1,804 

126.9 

1904 

1,430,676 

1,797 

125.6 

1905 

1,439,438 

1,909 

1.S2.6 

128.1 

1901-1905 

7,108,167 

9,105 

Table  150 
Mortality  from  Cancer  in  Lyons,  1910-1912 


Deaths  Rate  per 

Year                                          Population                from  100,000 

Cancer  Population 

1910 513,460                783  152.5 

1911 523,798                805  153.7 

1912 534,132               757  141.7 

1910-1912 1,571,388             2,345  149.2 

Source:     Yille  de  Lyon,   Bureau  Municipal  d'Hygiene 
et  de  statistique. 


Table  151 

Table  152 

Mortality 

from  Cancer  in  Bordeaux 

Mortality  from  Cancer  in 

Nice 

1909-1912 

Rate  per 

100,000 

Population 

Year 

1909-19] 

12 

Deaths 
from 
Cancer 

Year 

Population 

Deaths 
from 
Cancer 

Population 

Rate  per 

100,000 

Population 

1909 
1910 
1911 
1912 

257,786 
259,732 
261,678 
263,624 

262 
291 
309 
322 

101.6 
112.0 
118.1 
122.1 

113.5 

1909 
1910 
1911 
1912 

1909-1912 

139,456 
141,198 
142,940 
144,682 

134 
141 
155 

137 

96.1 

99.9 

108.4 

94.7 

1909-1912 

1,042,820 

1,184 

568,276 

567 

99.8 

Source:     Original  data  furnished  by  the 
Mayor  of  the  City  of  Bordeaux. 

Source:     Original  data  furnished  by  the 
Bureau  d'Hygiene,  Nice. 

672 


APPENDIX  G 

Table  153 

Mortality  from  Cancer  in  Lille 

1891-1912 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1891 

201,211 

241 

119.8 

1906 

205,625 

261 

126.9 

1892 

204,224 

234 

114.6 

1907 

208,061 

248 

119.2 

1893 

207,237 

254 

122.6 

1908 

210,497 

246 

116.9 

1894 

210,250 

239 

113.7 

1909 

212,933 

305 

143.2 

1895 

213,263 
1,036,185 

252 

118.2 
■   117.7 

1910 
1906-1910 

215,369 

311 

144.4 

1891-1895 

1,220 

1,052,485 

1,371 

130.3 

1896 
1897 
1898 

216,276 
216,107 
215,938 

235 
216 
254 

108.7 
100.0 
117.6 

1911 
1912 

217,807 
220.243 

316 
291 

145.1 
132.1 

1899 
1900 

215,769 
215,600 

235 
267 

108.9 
123.8 

111.8 

Source: 
pal  d'Hygi 

Ville  de  Lille.    Burea 
ene.     Travaux  statisi 

u  Munici- 
iques. 

1896-1900 

1,079,690 

1,207 

1901 

215,431 

248 

115.1 

1902 

213,470 

243 

113.8 

1903 

211,509 

246 

116.3 

1904 

209,548 

239 

114.1 

1905 

207,587 

265 
1,241 

127.7 
117.3 

1901-1905 

1,057,545 

Table  154 

Table  155 

Mortality  from  Cancer  in 

Nancy 

Mortality  from  Cancer  in  Le  H^vre 

1901-1912 

eaths 

rom 

ancer 

Rate  per 

100,000 

Population 

Year 

1901-1912 

Year 

D 

Population             i 
C 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1901 
1902 
1903 
1904 
1905 

102,559 
104,298 
106,037 
107,776 
109,515 

116 
118 
132 
119 
141 

113.1 
113.1 
124.5 
110.4 

128.7 

118.1 

1901 
1902 
1903 
1904 
1905 

1901-1905 

130,196 
130,642 
131.089 
131,536 
131,983 

154 
142 
138 
167 
153 

118.3 
108.7 
105.3 
127.0 
115.9 

1901-1905 

530,185 

626 

655,446 

754 

115.0 

1906 
1907 
1908 
1909 
1910 

111,254 
112,993 
114,732 
116,471 
118,210 

145 
144 
172 
129 
136 

130.3 
127.4 
149.9 
110.8 
115.0 

126.6 

1906 
1907 
1908 
1909 
1910 

1906-1910 

132,430 
133,175 
133,921 
134,667 
135,413 

177 
144 
195 
204 
160 

133.7 
108.1 
145.6 
151.5 
118.2 

1906-1910 

573,660 

726 

669,606 

880 

131.4 

1911 
1912 

119,949 
121.688 

128 
140 

106.7 
115.0 

1911 
1912 

136,159 
136,905 

166 
192 

121.9 
140.2 

Source:    Yille  de  Nancy, 
tistique  et  Demographique 

Annuaire  Sta- 

Source:     Rapport  de  la  commission  con- 
sultative du  Bureau  Municipal  d'Hygiene. 
Ville  du  Havre. 

673 


APPENDIX  G 


Table  156 
Mortality  from  Cancer  in  Switzer- 


land, 1881-1912 


Year 

1881 
1882 
1883 
1884 
1885 


Population 

1,115,193 
1,673,700 
1,851,993 
1,865,861 
2,896,079 


Deaths 
from 
Cancer 

1,398 
1,817 
1,928 
2,086 
3,089 


1881-1885     9,402,826       10,318 


Rate  per 

100,000 

Population 

125.4 
108.6 

104.1 
lll.S 
106.7 

109.7 


1886-1890  14,643,955   16,718 


1891-1895  15,197,361   18,612 


1896-1900  16,127,599   20,544 


1901-1905  17,142,770   21,995 


1906-1910  18,237,395   22,903 


1886  2,906.983  3,294  113.3 

1887  2,917,887  3,276  112.3 

1888  2,928,791  3,389  115.7 

1889  2,939,695  3,354  114.1 

1890  2,950,599  3,405  115.4 

114.2 

1891  2,965,053  3,528  119.0 

1892  3,002,263  3,706  123.4 

1893  3,039,472  3,653  120.2 

1894  3,076,682  3,802  123.6 

1895  3,113,891  3,923  126.0 

12-2.5 

1896  3,151,101    3,916     124.3 
1S97    3,188,310    4,088    128.2 

1898  3,225,520    4,125     127.9 

1899  3,262,729    4,1.30    126.6 

1900  3,299,939         4,285  129.9 

127.4 

1901  3,340,984  4,271  127.8 

1902  3,384,769  4,258  125.8 

1903  3,428,554  4,447  129.7 

1904  3,472,339  4,464  128.6 

1905  3,516,124  4,555  129.5 

128.3 

1906  3,559,909  4,593  129.0 

1907  3,603,694  4,413  122.5 

1908  3,647,479  4,669  128.0 

1909  3,691,264  4.676  126.7 

1910  3,735,049  4,612  123.5 

125.9 

1911  3,781,430         4,673  123.6 

1912  3,831,220         4,-598  120.0 

Source:  Die  Bewegung  der  Bevolker- 
ung  in  der  Schweiz  im  Jahre  1881-1885. 
Ehe,  Geburt  und  Tod  in  der  Schweizeri- 
sciien  Bevolkerung  wahrend  der  zwanzig 
Jahre  1871-1890. 

Statistiches  Jahrbuch  der  Schweiz  1912. 

Note:  Does  not  include  all  the  can- 
tons, 1881-1884. 


Table  157 
Mortality  from  Cancer  in  Switzer- 
land, Males 
1881-1885,  1901-1912 


Year 

1881 
1882 
1883 
1884 
1885 


Population 

546.445 
820,113 
907,477 
914,272 
1,419,079 


Deaths         Rate  per 


from 
Cancer 

662 
874 
875 
950 
1,456 


1881-1885     4,607,386         4,817 


1901 

1902 
1903 
1904 
1905 


1,637,082 
1,658,537 
1,679,991 
1,701,446 
1,722,901 


2,128 
2,102 
2,202 
2,250 
2,252 


1901-1905  8,399,957   10,934 


1906 
1907 
1908 
1909 
1910 


1,744.355 
1,765,810 
1,787,265 
1,808,719 
1,830,174 


2.342 
2,190 
2,318 
2,271 
2,310 


100,000 
Population 

121.1 
106.6 
96.4 
103.9 
102.6 

104.5 

130.0 
126.7 
131.1 
132.2 
130.7 

130.2 

134.3 
124.0 
129.7 
125.6 
126.2 


1906-1910     8,936,323       11,431  127.9 


1911 
1912 


1,852,901 
1,877,298 


2,342 
2,349 


126.4 
125.1 


Source:  Die  Bewegtmg  der  Bevolker- 
ung in  der  Schweiz  im  Jahre  1881-1885. 
Ehe,  Geburt  und  Tod  in  der  Schweizeri- 
schen  Bevolkerung  wahrend  der  zwanzig 
Jahre  1871-1890. 

Statistisches  Jahrbuch  der  Schweiz  1912. 

Note:  Does  not  include  aU  the  can- 
tons, 1881-1884. 


674 


APPENDIX  G 


Table  158 
Mortality  from  Cancer  in  Switzerland,  Females,  1881-1885,  1901-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

568,748 

736 

129.4 

1906 

1,815,554 

2,251 

124.0 

1882 

853,587 

943 

110.5 

1907 

1,837,884 

2,223 

121.0 

1883 

944,516 

1,053 

111.5 

1908 

1,860,214 

2,351 

126.4 

1884 

951,589 

1,136 

119.4 

1909 

1,882,545 

2,405 

127.8 

1885 

1,477,000 

1,633 

5,501 

110.6 
114.7 

1910 
1906-1910 

1,904,875 

2,302 

120.8 

1881-1885 

4,795,440 

9,301,072 

11,532 

124.0 

1901 

1,703,902 

2,143 

125.8 

1911 

1,928,529 

2,331 

120.9 

1902 

1,726,232 

2,156 

124.9 

1912 

1,953,922 

2,249 

115.1 

1903 

1,748,563 

2,245 

128.4 

Source: 

Die   Bewegune  der 

Bevblker- 

1904 

1,770,893 

2,214 

125.0 

ling  in  der  Schwciz  im  Jahre 

1881-1885. 

1905 

1,793,223 

2,303 

128.4 

Ehe,  Geburt  und  Tod 

in  der  Schweizeri- 

schen   Bevolkerung  wahrend  der  zwanzig 

1901-1905 

8,742,813 

11,061 

126.5 

Jahre  1871-1890. 

Statistisches  Jahrbuch  der  Schweiz  1912. 

Note: 

Does  not  include  all 

the    can- 

tons,  1881-1884. 

Table  159 

Mortality  from  Cancer  in  Switzerland,  by  Organs  and  Parts 

according  to  Sex,  1901-1910 


Deaths  from  Cancek 

Organ  or  Part  Total  Males  Females 

Tongue 516  478  38 

(Esophagus 4,067  3,447  620 

Larynx 1,093  946  147 

Stomach 18,235  10,256  7,979 

Intestines 2,220  937  1,283 

Rectum 1,683  981  702 

Bladder 604  434  170 

Prostate 311  311 

Breast 2,394  14  2,380 

Uterus 3,299  .  .  3,299 

Vagina,  testicle,  etc 304  97  207 

Ovaries 508  .  .  508 

Lips 153  129  24 

Skin,  face  and  nose 666  269  397 

Thyroid  gland 680  339  341 

Liver  and  gall-bladder.  3,277  1,270  2,007 

Spleen 17  8  9 

Pancreas '.  545  294  251 

Peritoneum 368  111  257 

Lungs  and  pleura 236  138  98 

Kidneys 254  144  110 

Bones  and  jaw 427  246  181 

Other  organs 784  376  408 

Sarcoma 2,317  1,140  1,177 

All  organs 44,958  22,365  22,593 

Source:     Statistisches  Jahrbuch  der  Schweiz,  1912. 


Rate  per 

100,000  Population 

Total 

Males 

Females 

1.46 

2.76 

0.21 

11.50 

19.88 

3.44 

3.09 

5.46 

0.81 

51.54 

59.16 

44.22 

6.27 

5.40 

7.11 

4.76 

5.66 

3.89 

1.71 

2.50 

0.94 

0.86' 

1.79 

6.77 

0.08 

13.19 

9.32 

18.28 

0.86 

0.56 

1.15 

1.44 

2.82 

0.43 

0.74 

0.13 

1.88 

1.55 

2.20 

1.92 

1.96 

1.89 

9.26 

7.33 

11.12 

0.05 

0.05 

0.05 

1.54 

1.70 

1.39 

1.04 

0.64 

1.42 

0.67 

0.80 

0.54 

0.72 

0.83 

0.61 

1.21 

1.42 

1.00 

2.22 

2.17 

2.26 

6.55 

6.58 

6.52 

127.07 

129.01 

125.21 

675 


APPENDIX  G 

Table  160 

Mortality  from  Cancer  in  Switzerland,  1901-1910 

Relative  Mortality  of  Females,  by  Organs  and  Parts 


Rate  per  100,000  Population 

Organ  or  Part  Males  Females 

Breast 0.08  13.19 

Generative  organs 0.56  22.25 

Peritoneum 0.64  1.42 

Liver  and  gall-bladder 7.33  11.12 

Skin,  face  and  nose 1.55  2.20 

Other  or  not  specified  organs 2.17  2.26 

Sarcoma 6.58  6.52 

Intestines,  rectum  and  pancreas 12.81  12.44 

Thyroidgland 1.96  1.89 

Stomach 59.16  44.22 

Bonesandjaw 1.42  1.00 

Lungs  and  pleura 0.80  0.54 

Kidneys  and  bladder 3.33  1.55 

Lips 0.74  0.13 

(Esophagus 19.88  3.44 

Larynx 5.46  0.81 

Tongue 2.76  0.21 


Relative  Mortality 
of  Females 

16,488 
3,973 
222 
152 
142 
104 

99 

97 

96 

75 

70 

68 

47 

18 

17 

15 


97 


All  organs 129.01  125.21 

Note:     In  this  table  the  mortality  of  males  from  cancer  of  any  organ  or  part  is  taken 
as  100  and  the  corresponding  mortality  of  females  is  given  accordingly. 

Table  161 

Mortality  from  Cancer  in  Switzerland,  by  Organs  and  Parts 

according  to  Sex,  1906-1910 


MALES 

Deaths  Rate  per 

Organ  or  Part                                  from  100,000 

Cancer  Population 

Lips 74  0.8 

Tongue 265  3.0 

(Esophagus *.'. 1,763  19.7 

Stomach 5,045  56.5 

Liver  and  gall-bladder 707  7.9 

Peritoneum  and  mesentery 54  0.6 

Intestines 515  5.8 

Rectum 544  6.1 

Pancreas 168  1.9 

Ovaries 

Uterus 

Breast 10  0.1 

Skin 123  1.4 

Larynx 520  5.8 

Lungs  and  pleura 72  0.8 

Kidneys .        67  0.7 

Bladder 204  2.3 

Prostate 194  2.2 

Other  or  not  specified 478  5.3 

Sarcoma 628  7.0 

All  organs 11,431  127.9 

Males,  45  years  and  over,  21.51  percent,  of  population. 
23.66  per  cent,  of  population.     (Census  of  1900.) 


FEMALES 

Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

9 

0.1 

20 

0.2 

304 

3.3 

3,987 

42.9 

1,032 

11.1 

124 

1.3 

695 

7.5 

370 

4.0 

138 

1.5 

276 

3.0 

1,609 

17.3 

1,264 

13.6 

221 

2.4 

78 

0.8 

60 

0.6 

60 

0.6 

84 

0.9 

56  i 

6.6 

640 

6.9 

11,532  124.0 

Females,  45  years  and  over. 


676 


APPENDIX  G 

Table  162 

Mortality  from  Cancer  in  Switzerland,  by  Cantons  and  Race 

1906-1910 


Canton  Population 

Zurich 2,370,861 

Bern 3,242,609 

Luzern 806,093 

Uri 107,601 

Schwyz 304,565 

Obwalden 83,892 

Niedwalden 71,126 

Glarus 178,726 

Zug 138,604 

Soluthorn 554,417 

Basel-Stadt 616,424 

Basel-Land 377,514 

Schaffhausen. .  .- 227,967 

Appenzell  A.-Rh 304,565 

Appenzell  I.-Rh 74,773 

St.  GaUen 1,376,923 

Aargau 1,136,190 

Thurgau 621,895 

Total  German 12,594,745 

Fribourg 703,963 

Vaud 1,548,355 

Valais 629,190 

Neuchatel 694,845 

Geneve 729,496 

Total  French, 4,305,849 

Ticino 762,323 

Grisons 574,478 

Italian  and  Romanish 1,336,801 


Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

3,255 

137.3 

3,224 

99.4 

1,342 

166.5 

123 

114.3 

453 

148.7 

131 

156.2 

119 

167.3 

308 

172.3 

208 

150.1 

672 

121.2 

704 

114.2 

401 

106.2 

258 

113.2 

412 

135.3 

136 

181.9 

2,040 

148.2 

1,497 

131.8 

876 

140.9 

16,159 

128.3 

825 

117.2 

1,538 

99.3 

280 

44.5 

686 

98.7 

931 

127.6 

4,260 

98.9 

684 

89.7 

578 

100.6 

l,s 


94.4 


Table  163 

Mortality  from  Cancer  in  Switzerland,  by  Age  and  Sex 

1901-1910 


MALES 

FEMALES 

Deaths 

Rate  per 

Deaths 

Rate  per 

Summary 

from 

100,000 

Summary 

from 

100,000 

Ages 

Population 

Cancer 

Population 

Ages 

Population 

Cancer 

Population 

Under  20 

7,182,421 

196 

2.7 

Under  20 

7,159,813 

166 

2.3 

20-29 

3,035,583 

205 

6.8 

20-29 

3,096,331 

207 

6.7 

30-39 

2,404,542 

543 

22.6 

30-39 

2,468,403 

900 

36.5 

40-49 

1,790,838 

2,253 

125:8 

40-49 

1,918,065 

2,829 

147.5 

50-59 

1,423,308 

5,377 

377.8 

50-59 

1,620,341 

5,101 

314.8 

60-69 

970,832 

8,000 

824.0 

60-69 

1,151,200 

7,319 

635.8 

70-79 

447,276 

4,971 

1,111.4 

70-79 

528,686 

4,972 

940.4 

80  and  over       81,480 

820 

1,006.4 
129.0 

80  and  ov 

All  Ages 

er     101,046 

1,099 

1,087.6 

All  Ages 

17,336,280 

22,365 

18,043,885 

22,593 

125.2 

Source : 

Statistisches     Jahrbuch     der 

Schweiz 

1912. 

677 


APPENDIX  G 


Table  164 

Table  165 

Mortality  from  Cancer  in^Bern 

Mortality  from  Cancer  in  Basel 

1901- 

1912 

Rate  per 

100,000 

Population 

Year 

1901- 

1912 

Year 

Population 

Deaths 
from 
Cancer 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1901 

65,295 

76 

116.4 

1901 

110,310 

90 

81.6 

1902 

67,071 

73 

108.8 

1902 

112,672 

103 

91.4 

1903 

69,035 

72 

104.3 

1903 

115,351 

101 

87.6 

1901. 

71,037 

66 

92.9 

1904 

118,060 

114 

96.6 

1905 

72,671 

80 

110.1 
106.3 

1905 
1901-1905 

120,738 

135 

111.8 

1901-1905 

345,109 

367 

577,131 

543 

94.1 

1906 

74,499 

89 

119.5 

1906 

123,637 

134 

108.4 

1907 

76,174 

77 

101.1 

1907 

126,575 

114 

90.1 

1908 

77,604 

87 

112.1 

1908 

128,726 

124 

96.3 

1909 

82,284 

83 

100.9 

1909 

128,691 

155 

120.4 

1910 

84,755 

96 

113.3 
109.3 

1910 
1906-1910 

131,308 

157 

119.6 

1906-1910 

395,316 

432 

638,937 

684 

107.1 

1911 

85,780 

75 

87.4 

1911 

133,470 

158 

118.4 

1912 

86,900 

105 

120.8 

1912 

135,632 

158 

116.5 

Source:     Die   Bewegung   der 
ung  in  der  Schweiz. 

Bevblker- 

Source:     Die   Bewegung   der 
ung  in  der  Schweiz. 

Bevolker- 

Table  166 

Table  167 

Mortality  from  Cancer  in 

Geneva 

Mortality  from  Cancer  in 

Zurich 

1901- 

1912 

Rate  per 

100,000 

Population 

Year 

1901- 

1912 

Year 

Population 

Deaths 
from 
Cancer 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1901 

105,517 

132 

125.1 

1901 

150,377 

160 

106.4 

1902 

108,336 

128 

118.2 

1902 

151,797 

168 

110.7 

1903 

111,244 

145 

130.3 

1903 

155,964 

175 

112.2 

1904 

115,587 

116 

100.4 

1904 

161,100 

179 

111.1 

1905 

113,144 

144 

127.3 
120.1 

1905 
1901-1905 

166,126 

190 

114.4 

1901-1905 

553,828 

665 

785,364 

872 

111.0 

1906 

116,445 

143 

122.8 

1906 

170,683 

188 

110.1 

1907 

118,594 

142 

119.7 

1907 

175,149 

196 

111.9 

1908 

121,192 

133 

109.7 

1908 

178,831 

186 

104.0 

1909 

120,063 

149 

124.1 

1909 

183,650 

221 

120.3 

1910 

122,391 

150 

122.6 

119.8 

1910 
1906-1910 

189,065 

197 

104.2 

1906-1910 

598,685 

717 

897,378 

988 

110.1 

1911 

128,000 

149 

116.4 

1911 

194,480 

203 

104.4 

1912 

130,000 

185 

142.3 

1912 

199,000 

246 

123.6 

Source:     Die  Bewegung  der  Bevcilkerung 
in  der  Schweiz. 

Source :     Die  Bewegung  der  Bevolkerung 
in  der  Schweiz. 

678 


APPENDIX  G 

Table  168 

Mortality  from  Cancer  in  Austria 

1895-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1895 

24,650,770 

15,757 

63.9 

1906 

27,355,419 

21,391 

78.2 

1907 

27,598,480 

21,431 

77.7 

1896 

24,898,222 

16,410 

65.9 

1908 

27,843,525 

21,788 

78.3 

1897 

25,153,390 

17,109 

68.0 

1909 

28,070,718 

22,180 

79.0 

1898 

25,397,725 

17,667 

69.6 

1910 

28,324,940 

22,157 

78.2 

1899 

25,655,952 

17,961 

70.0 

1900 

25,921,671 

18,423 

71.1 

68.9 

1906-1910 
1911 

139,193,082 
28,516,220 

108,947 
23,585 

78.3 

1896-1900 

127,026,960 

87,570 

82.7 

1912 

28,707,500 

23,511 

81.9 

1901 

26,178,756 

19,154 

73.2 

1902 

26,434,201 

19,685 

74.5 

Source: 

Bewegung  der  Bevolkerung  der 

1903 

26,668,312 

19,728 

74.0 

im     Reichsrate    vertretenea     Konicreiche 

1904 

26,916,299 

20,231 

75.2 

und  Laader. 

1905 

27,083,056 

20,744 

76.6 

74.7 

1901-1905 

133,280,624 

99,542 

Table  169 

Mortality  from  Cancer  in  Austria,  by  Sex 

1901-1912 


MALES 

FEMALES 

Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1901 

12,749,054 

8,722 

68.4 

1901 

13,429,702 

10,432 

77.7 

1902 

12,873,456 

8,974 

69.7 

1902 

13,560,745 

10,711 

79.0 

1903 

12,984,801 

8,932 

68.8 

1903 

13,683,511 

10,796 

78.9 

1904 

13,105,546 

9,099 

69.4 

1904 

13,810,753 

11,132 

80.6 

1905 

13,186,740 

9,446 

71.6 
69.6 

1905 
1901-190. 

13,896,316 

11,298 

81.3 

1901-1905 

64,899,597 

45,173 

5  68,381,027 

54,369 

79.5 

1906 

13,316,618 

9,834 

73.8 

1906 

14,038,801 

11,557 

82.3 

1907 

13,434,940 

9,846 

73.3 

1907 

14,163,540 

11,585 

81.8 

1908 

13,554,228 

10,139 

74.8 

1908 

14,289,297 

11,649 

81.5 

1909 

13,662,018 

10,340 

75.7 

1909 

14,408,700 

11,840 

82.2 

1910 

13,787,028 

10,242 
50.401 

74.3 
74.4 

1910 
1906-191( 

14,537,912 

11,915 

82.0 

1906-1910 

67,754,832 

)  71,438,250 

58,546 

82.0 

1911 

13,878,844 

11,090 

79.9 

1911 

14,637,376 

12,495 

85.4 

1912 

13,970,660 

11,131 

79.7 

1912 

14,736,840 

12,380 

84.0 

Source 

Bewegung  der  Bevolkerung  der 

im    Reichsrate    vertretenen     K 

onigreiche 

und  Lander. 

679 


APPENDIX  G 

Table  170 

Mortality  from  Cancer  in  Austria,  by  Provinces  and  Race 

1907-1911 


Province  Population 

Lower  Austria 17,272,023 

Upper  Austria 4,201,966 

Salzburg 1,052,264 

Styria 7,210,591 

Carinthia 1,947,234 

Tyrol 4,640,064 

V'orarlberg 711,880 

Silesia 3,709,688 

Total  German 40,745,710 

Trieste  Italian 1,110,874 

Carniola 2,594,840 

Goritz  and  Gradiska 1,276,793 

Total  Slovenic 3,871,633 

Istria 1,968,684 

Dalmatia 3,170,366 

Total  Serbo-Croatic 5,139,050 

Bohemia 33,293,281 

Moravia 12,891,685 

Total  Bohemian 46,184,966 

Galicia 39,375,765 

Bukowina 3,925,885 

Total  Polish-Ruthenian. .  43,301,650 

Total  for  Austria 140,353,883 

Source:     Osterreichische  Statistik: 
tenen  Konigreiche  und  Lander. 


Deaths  Rate  per 

from  100,000 

Cancer  Population 

20,632  119.5 


Race  Constitution,  1910 


5,708 
1,474 
6,918 
1,622 
5,081 
890 
2,482 


1,267 

587 


34,642 

12,484 


111,141 


135.8 

140.1 

95.9 

83.3 

109.5 

125.0 

66.9 


95.9%  German 
99.7%  German 
99.7%  German 


44,807       110.0 


99.7%  German 

70.5%  German,  29.4%  Slovenic 

78.6%  German,  21.2%  Slovenic 

57.3%  German,  42.1%  Italian 

95.4%  German 

43.9%  German,  31.7%  Polish, 

24.3%  Bohemian 


1,103        99.3      62.3%  Italian,  29.8%  Slovenic 


48.8       94.4%  Slovenic 

46.0       61.9%  Slovenic,  36.1%  Italian 

47.9 

42.6       43.5%  Serbo-Croatic,  38.1%  Ital- 
ian, 14.3%  Slovenic 
24.4       96.2%  Serbo-Croatic 


31.S 


104.1 


63.2%  Bohemian,  36.8%  German 
71.8%  Bohemian,  27.6%  German 


47,126       103.0 


12,844         32.6       58.6%  Polish,  40.2%  Ruthenian 
1,796         45.7       38.4%  Ruthenian,  34.4%  Ruma- 


14,640        33.8 


79.2 


35.58%  German,  60.65%  Slavic, 
3.73%  Latin,  0.4%  Magyar. 
Bewegung  der  Bevolkerung  der  im  Reichsrate  vertre- 


680 


APPENDIX  G 

Table  171 

Mortality  from  Malignant  Tumors  in  Austrian  Cities 

1909-1910 


City  Population  1909 

Vienna 3,993,125  2,220 

Prague 443,051  202 

Lemberg 402,978  188 

Trieste 439,947  199 

Krakau 291,760  128 

Graz 300,822  248 

Briinn 248,195  153 

Source:     Osterreichisches  Stadtebuch.     14. 
Note:     Non-residents  are  excluded. 


Deaths  from  Cancer 

Rate  per 
100,000 

1910 

1909-1910 

Population 

2,319 

4,539 

113.7 

281 

483 

109.0 

194 

382 

94.8 

184 

383 

87.1 

129 

257 

88.1 

215 

463 

153.9 

109 

262 

105.6 

Band. 


Table  172 

Mortality  from  Cancer  in 

Vienna 

1900-1912 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1900 

1,662,124 

1,915 

115.2 

1901 
1902 
1903 
1904 
1905 

1,687,790 
1,714,007 
1,740,638 
1,767,690 
1,856,408 

1,951 
1,884 
2,137 
2,099 
2,135 

10,206 

115.6 
109.9 
122.8 
118.7 
115.0 

901-1905 

8,766,533 

116.4 

1906 
1907 
1908 
1909 
1910 

1,886,652 
1,917,396 
1,948,648 
1,980,416 
2,012,709 

2,080 
2,406 
2,505 
2,469 
2,558 

110.2 
125.5 
128.6 
124.7 
127.1 

906-1910 

9,745,821 

12,018 

123.3 

1911 
1912 

2,045,002 

2,077,295 

2,680 
2,759 

131.1 
132.8 

Source :  Bericht  des  Wiener  Stadtphysi- 
kates. 

Bewegung  der  Bevolkerung  der  im 
Reichsrate  vertretenen  Konigreiche  und 
Lander. 

Statistisches  Jahrbuch  der  Stadt  Wien. 


681 


APPENDIX  G 


Table  173 

Mortality  from  Cancer  in  Vienna,  by  Sex 

1900-1912 


MALES 

FEMALES 

Year 
1900 

Population 
796,562 

Deaths 
from 
Cancer 

782 

Rate  per 

100,000 

Population 

98.2 

Year 
1900 

Population 

865,562 

Deaths 
from 
Cancer 

1,133 

Rate  per 

100,000 

Population 

130.9 

1901 
1902 
1903 
1904 
1905 

808,924 
821,489 
834,253 
847,218 
889,739 

773 
837 
956 
886 
934 

95.6 
101.9 
114.6 
104.6 
105.0 

104.4 

1901 
1902 
1903 
1904 
1905 

1901-1905 

878,866 
892,518 
906,385 
920,472 
966,669 

1,178 
1,047 
1,181 
1,213 
1,201 

134.0 
117.3 
130.3 
131.8 
124.2 

1901-1905 

4,201,623 

4,386 

4,564,910 

5,820 

127.5 

1906 
1907 
1908 
1909 
1910 

904,235 
918,970 
933,948 
949,174 
964,651 

881 
1,079 
1,094 
1,102 
1,159 

97.4 
117.4 
117.1 
116.1 
120.1 

113.8 

1906 
1907 
1908 
1909 
1910 

1906-1910 

982,417 

998,426 

1,014,700 

1,031,242 

1,048,058 

1,199 
1,327 
1,411 
1,367 
1,399 

122.0 
132.9 
139.1 
132.6 
133.5 

1906-1910 

4,670,978 

5,315 

5,074,843 

6,703 

132.1 

1911 
1912 

980,128 
995,605 

1,194 
1,301 

121.8 
130.7 

1911 
1912 

1,064,874 
1,081,690 

1,486 
1,458 

139.5 
134.8 

Source:     Bericht  des  Wiener  Stadtphysi- 
kates. 

Statistisches  Jahrbucli  der  Stadt  Wien. 


Table  174 
Mortality  from  Cancer  among  the  Jewish  Population  of  Vienna 

1898-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1898 

140,718 

125 

88.8 

1906 

163,962 

196 

119.5 

1899 

142,825 

113 

79.1 

1907 

166,801 

341 

204.4 

1900 

146,926 

122 

83.0 

1908 

169,640 

311 

183.3 

1909 

172,479 

364 

211.0 

1901 
1902 

149,766 
152,606 

134 
139 

89.5 
91.1 

1910 

175,318 

250 

142.6 

1903 

155,445 

95 

61.1 

1906-1910 

848,200 

1,462 

172.4 

1904 

158,284 

156 

98.6 

1905 

161,123 

180 

111.7 

1911 

178,157 

240 

134.7 

1912 

180,996 

226 

124  9 

1901-1905 

777,224 

704 

90.6 

Source: 

Bericht    des    Vorstandes    der 

Israelitischen    Kultusgemeinde 

in    Wien 

iiber  seine 

Tatigkeit. 

(Biennial 

reports.) 

682 


APPENDIX  G 

Table  175 

Proportionate  Mortality  from  Cancer  among  the  Jewish   Population    of 

Vienna,  by  Sex,  1898-1912 


MALES 

FEMALES 

Year 

Deaths 
from  All 
Causes 

Deaths 
from 
Cancer 

Cancer  in 

Per  Cent,  of 

All  Causes 

,       Year 

Deaths 
from  All 
Causes 

Deaths 
from 
Cancer 

Cancer  in 
Per  Cent  of 
All  Causes 

1898 

996 

69 

6.9 

1898 

768 

56 

7.3 

1899 

1,058 

66 

6.2 

1899 

858 

47 

5.5 

1900 

1,027 

63 

6.1 

1900 

853 

59 

6.9 

1901 

1,053 

63 

6.0 

1901 

893 

71 

8.0 

1902 

1,111 

72 

6.5 

1902 

897 

67 

7.5 

1903 

1,011 

42 

4.2 

1903 

846 

53 

6.3 

1904 

1,065 

83 

7.8 

1904 

917 

73 

8.0 

1905 

1,131 

92 
352 

8.1 
6.6 

1905 
1901-1905 

971 

88 
352 

9.1 

1901-1905 

5,371 

4,524 

7.8 

1906 

1,136 

101 

8.9 

1906 

841 

95 

11.3 

1907 

1,089 

174 

16.0 

1907 

911 

167 

18.3 

1908 

1,148 

150 

13.1 

1908 

986 

161 

16.3 

1909 

1,248 

197 

15.8 

1909 

1,000 

167 

16.7 

1910 

1,195 

119 

741 

10.0 

12.7 

1910 
1906-1910 

991 

131 

721 

13.2 

1906-1910 

5,816 

4,729 

15.2 

1911 

1,249 

112 

9.0 

1911 

1,059 

128 

12.1 

1912 

1,264 

124 

9.8 

1912 

987 

102 

10.3 

Source: 

Bericht    des 

Vorstandes    der 

Israelitischen     Kultusgemeinde    in     Wien 
iiber  seine  Tatigkeit.     (Biennial  reports.) 

Table  176 

Mortality  from  Cancer  in  Hungary 

1897-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1897 

18,554,494 

5,388 

29.0 

1906 

20,099,028 

8,229 

40.9 

1898 

18,738,579 

5,458 

29.1 

1907 

20,210,113 

8,635 

42.7 

1899 

18,927,595 

5,267 

27.8 

1908 

20,458,762 

9,022 

44.1 

1900 

19,144,142 

7,021 

36.7 

1909 

20,606,760 

9,175 

.44.5 

1910 

20,792,709 

9,489 

45.6 

1897-1900 

75,364,810 

23,134 

30.7 

• 

1906-1910 

102,167,372 

44,550 

43.6 

1901 

19,342,190 

6,941 

35.9 

1902 

19,513,336 

7,461 

38.2 

1911 

20,980,265 

9,718 

46.3 

1903 

19,669,177 

7,742 

39.4 

1912 

21,168,000 

9,970 

47.1 

1904 
1905 

19,831,663 
19,869,296 

8,112 
8,110 

40.9 
40  8 

Source: 

Ungarisches  statistisches  Jahr- 

39.1 

buch,  1897-1899.     A  Magyar  szei 
orszagainak,  1900-1908  evi.,  Nepn 
Budapest. 

Ungarisches  statistisches  Jahrbi 

it  korona 

1901-1905 

98,225,662 

38,366 

lozgalma. 

ich,  1909. 

Annuaire    statistique 

Hongrois.,    1910- 

1912. 

683 


APPENDIX  G 

Table  177 

Mortality  from  Cancer  in  Hungary,  by  Sex 

1897-1908 


MALES 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Cancer 

Population 

1897 

9,232,716 

2,276 

24.7 

1898 

9,324,317 

2,301 

24.7 

1899 

1900 

9,526,125 

3,080 

32.3 

1901 

9,620,805 

3,135 

32.6 

1902 

9,702,031 

3,396 

35.0 

1903 

9,775,581 

3,428 

35.1 

1904 

9,852,370 

3,627 

36.8 

1905 

9,867,092 

3,521 

35.7 

1901-1905 

48,817,879 

17,107 

35.0 

1906 

9,977,157 

3,593 

36.0 

1907 

10,028,258 

3,803 

37.9 

1908 

10,145,500 

4,011 

39.5 

1906-1908 

30,150,915 

FEMALES 

11,407 

37.8 

1897 

9,321,778 

3,112 

33.4 

1898 

9,414,262 

3,157 

33.5 

1899 

1900 

9,618,017 

3,941 

41.6 

1901 

9,721,385 

3,806 

39.2 

1902 

9,811,305 

4,065 

41.4 

1903 

9,893,596 

4,314 

43.6 

1904 

9,979,293 

4,485 

44.9 

1905 

10,002,204 

4,589 

45.9 

1901-1905 

49,407,783 

21,259 

43.0 

1906 

10,121,871 

4,636 

45.8 

1907 

10,181,855 

4,832 

47.5 

1908 

10,313,262 

5,011 

48.6 

1906-1908 

30,616,988 

14,479 

47.3 

Source:  Ungarisches  statistisches  Jahrbuch,  1897-1899. 
A  Magj'ar  szent  korona  orszagainak,  1900-1908  evi,  Nepmoz- 
galma,  Budapest. 


684 


APPENDIX  G 

Table  178 
Mortality  from  Cancer  in  Hungary,  by  Organs  and  Parts,  aceording  to  Sex 

1901-1904 


MALES 


Organ  or  Pait 


Lips 

Tongue 

Mouth 

(Esophagus 

Stomach 6,098 

Liver 

Pancreas 

Rectum 

Other  intestines 

Peritoneum 

Larynx 

Kidney 

Bladder 

Thyroid  gland 

Male  generative  organs 

Uterus 

Other  female  generative  organs 

Breast 

Bones 

Skin 

Other  organs 

Not  specified 


Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

179 

0.5 

359 

0.9 

218 

0.6 

329 

0.8 

6,098 

15.7 

1,245 

3.2 

28 

0.1 

243 

0.6 

755 

1.9 

11 

0.0 

390 

1.0 

61 

0.2 

435 

1.1 

78 

0.2 

66 

0.2 

8 

0.0 

115 

0.3 

524 

1.3 

114 

0.3 

720 

1.8 

All  organs 11,976 


30.7 


Source:     Ungarische  statistische  Mitteilungen.     Neue  Serie,  19.  Band 
Krebskranken  in  den  Landern  der  Ungarischen  heiligen  Krone. 


FEMALES 

Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

28 

0.1 

37 

0.1 

46 

0.1 

57 

0.1 

5,116 

13.0 

1,318 

3.3 

13 

0.0 

209 

0.5 

912 

2.3 

49 

0.1 

75 

0.2 

68 

0.2 

108 

0.3 

16 

0.0 

4,596 

11.7 

96 

0.2 

934 

2.4 

42 

0.1 

343 

0.9 

128 

0.3 

745 

2.0 

14,936 

37.9 

and.     Statistik  der 

Table  179 

Percentage  Distribution  of  Cancer  Cases  in  Hungary 

by  Organs  and  Parts,  according  to  Sex,  1904 


MALES 


Organ  or  Part 

Lips 

Digestive  system 

Urinary  system 

Breast 

Generative  system.  .  . 
Respiratory  system. . . 

Nervous  system 

Other  glands 

Bones 

Skin  of  head  and  face. 
Skin  of  other  parts .  . . 


Cases 

Per  Cent 

415 

30.12 

542 

39.33 

14 

1.02 

6 

0.44 

35 

2.54 

27 

1.96 

1 

0.07 

13 

0.94 

44 

3.19 

243 

17.63 

38 

2.76 

All  organs 1,378 


100.00 


Source:     Ungarische  statistische  Mitteilungen.     Neue  Serie,  19.  Band 
Krebskranken  in  den  Landern  der  Ungarischen  heiligen  Krone. 


FEMALES 

Case" 

Per  Cent. 

39 

1.79 

333 

15.28 

11 

0.50 

496 

22.76 

972 

44.61 

6 

0.28 

0.00 

10 

0.46 

21 

0.96 

245 

11.24 

46 

2.11 

2,179 

100.00 

nd.     Statistik  der 

685 


APPENDIX  G 

Table  180 

Mortality  from  Cancer  in  Hungary,  by  Race 

1901-1904 


Race  Population 

Magyar 36,141,954 

German 8,411,451 

Rumanian 11,305,074 

Slovak 7,996,899 

Croatian 6,843,219 

Serbian ; 4,247,087 

Ruthenian 1,754,347 

Others 1,656,335 

Total 78,356,366 

Source:     Ungarische  statistische  Mitteilungen.     Neue  Serie,  19 
Krebskranken  in  den  Landern  der  Ungarischen  heiligen  Krone. 


Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

15,950 

44.1 

4,741 

56.4 

1,280 

11.3 

2,278 

28.5 

1,226 

17.9 

819 

19.3 

80 

4.6 

538 

32.5 

26,912 

34.3 

.  Band. 

Statistik  der 

Table  181 

Mortality  from  Cancer  in  Budapest 

1881-1912 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1881 

377,393 

221 

58.6 

1901 

738,602 

598 

81.0 

1882 

390,646 

253 

64.8 

1902 

749,092 

720 

96.1 

1883 

403,899 

294 

72.8 

1903 

759,579 

737 

97.0 

1884 

417,152 

277 

66.4 

1904 

770,067 

779 

101.2 

1885 

430,405 

248 

57.6 
64.0 

1905 
1901-1905 

780,560 

716 

91.7 

1881-1885 

2,019,495 

1,293 

3,797,900 

3,550 

93.5 

1886 

443,658 

303 

68.3 

1906 

791,748 

732 

92.5 

1887 

456,911 

332 

72.7 

1907 

810,664 

834 

102.9 

1888 

470,164 

314 

66.8 

1908 

829,580 

819 

98.7 

1889 

483,417 

313 

64.7 

1909 

848,496 

858 

101.1 

1890 

496,670 

327 

65.8 
67.6 

1910 
1906-1910 

867,412 

936 

107.9 

1886-1890 

2,350,820 

1,589 

4,147,900 

4,179 

100.7 

1891 

517,616 

449 

86.7 

1911 

886,328 

843 

95.1 

1892 

540,079 

477 

88.3 

1912 

905,244 

994 

109.8 

1893 
1894 

562,543 
585,008 

391  • 
434 

69.5 

74.2 

Source : 

Die  Sterblichkeit  der  Stadt  Bu- 

1895 

607,471 

493 

81.2 

dapest. 

1891-1895 

2,812,717 

2,244 

79.8 

Stadt  Budapest. 

1896 

629,934 

415 

65.9 

1897 

652,397 

483 

74.0 

1898 

674,862 

506 

75.0 

1899 

697,325 

533 

76.4 

1900 

719,788 

554 

77.0 
73.8 

1896-1900 

3,374,306 

2,491 

686 


APPENDIX  G 


Table  182 

Mortality  from  Cancer  in  Budapest 

Males,  1881-1912 


Table  183 

Mortality  from  Cancer  in  Budapest 

Females,  1881-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

189,866 

62 

32.7 

1881 

187,527 

159 

84.8 

1882 

196,456 

75 

38.2 

1882 

194,190 

178 

91.7 

1883 

203,040 

94 

46.3 

1883 

200,859 

200 

99.6 

1884 

209,619 

88 

42.0 

1884 

207,533 

189 

91.1 

1885 

216,192 

96 

44.4 
40.9 

1885 
1881-1885 

214,213 

152 

71.0 

1881-1885 

1,015,173 

415 

1,004,322 

878 

87.4 

1886 

222,761 

111 

49.8 

1886 

220,897 

192 

86.9 

1887 

229,324 

121 

52.8 

1887 

227,587 

211 

92.7 

1888 

235,881 

121 

51.3 

1888 

234,283 

193 

82.4 

1889 

242,434 

101 

41.7 

1889 

240,983 

212 

88.0 

1890 

248,931 

113 

45.4 
48.1 

1890 
1886-1890 

247,739 

214 

86.4 

1886-1890 

1,179,331 

567 

1,171,489 

1,022 

87.2 

1891 

259,119 

164' 

63.3 

1891 

258,497 

285 

110.3 

1892 

269,985 

181 

67.0 

1892 

270,094 

296 

109.6 

1893 

280,878 

127 

45.2 

1893 

281,665 

264 

93.7 

1894 

291,685 

139 

47.7 

1894 

293,323 

295 

100.6 

1895 

302,460 

190 

62.8 
57.0 

1895 
1891-1895 

305,011 

303 

99.3 

1891-1895 

1,404,127 

801 

1,408,590 

1,443 

102.4 

1896 

313,266 

150 

47.9 

1896 

316,668 

265 

83.7 

1897 

323,980 

172 

53.1 

1897 

328,417 

311 

94.7 

1898 

334,664 

199 

59.5 

1898 

340,198 

307 

90.2 

1899 

345,385 

194 

56.2 

1899 

351,940 

339 

96.3 

1900 

356,079 

201 

56.4 
54.7 

1900 
1896-1900 

363,709 

353 

97.1 

1896-1900 

1,673,374 

916 

1,700,932 

1,575 

92.6 

1901 

365,165 

256 

70.1 

1901 

373,437 

342 

91.6 

1902 

370,126 

275 

74.3 

1902 

378,966 

445 

117.4 

1903 

375,156 

308 

82.1 

1903 

384,423 

429 

111.6 

1904 

380,182 

327 

86.0 

1904 

389,885 

452 

115.9 

1905 

385,206 

302 

78.4 
78.3 

1905 
1901-1905 

395,354 

414 

104.7 

1901-1905 

1,875,835 

1,468 

1,922,065 

2,082 

108.3 

1906 

390,569 

301 

77.1 

1906 

401,179 

431 

107.4 

1907 

399,738 

319 

79.8 

1907 

410,926 

515 

125.3 

1908 

408,900 

338 

82.7 

1908 

420,680 

481 

114.3 

1909 

418,054 

337 

80.6 

1909 

430,442 

521 

121.0 

1910 

427,200 

442 

103.5 
85.0 

1910 
1906-1910 

440,212 

494 

112.2 

1906-1910 

2,044,461 

1,737 

2,103,439 

2,442 

116.1 

1911 

436,346 

.344 

78.8 

1911 

449,982 

499 

110.9 

1912 

445,492 

428 

96.1 

1912 

459,752 

566 

123.1 

Source: 

Die  Sterblichkeit  der 

Stadt  Bu- 

Source: 

Die  SterbUchkeit  der  Stadt  Bu- 

dapest. 

dapest. 

Statistisch-Administratives  Jahrbuch  der 

Statistisch-Administratives  Jahrbuch  der 

Stadt  Budapest. 

Stadt  Budapest. 

687 


APPENDIX  G 

Table  184 
Mortality  from  Cancer  in  Budapest,  by  Religious  Confession 

1902-1906 

NON-JEWISH  MORTALITY 

Carcinoma  Carcinoma  Uteri 

Deaths  Per  Cent.  Per  Cent. 

Year                                           from  All  Deaths  of  All  Deaths  of  All 

Causes  Causes  Carcinoma 

1902              12,332  702  5.69  162  23.1 

1903 12,591  708  5.62  132  18.6 

1904 12,821  817  6.37  157  19.2 

1905 13,471  714  5.30  127  17.8 

1906 13,880  602  4.34  137  22.8 

1902-1906 65,095  3,543  5.44  715  20.2 

JEWISH  MORTALITY 

1902      2,400  167  6.96  10  6.0 

1903 2,468  188  7.62  18  9.6 

1904 2,614  192  7.35  13  6.8 

1905 2,623  153  5.83  15  9.8 

1906 2,500  183  7.32  12  6.6 

1902-1906 12,605  883  7.01  68  7.7 

Source:     F.  Theilhaber:     Sociale  Stellung  und  Rasse  bei  Uteruscarcinom.     In:  Zeit- 
schrift  fiir  Krebsforschung,  8.  Band. 

Table  185 

Mortality  from  Cancer  in  Italy 

1887-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1887 

29,614,430 

12,631 

42.7 

1901 

32,533,337 

17,141 

52.7 

1888 

29,825,022 

12,625 

42.3 

1902 

32,699,510 

17,634 

53.9 

1889 

30,035,038 

12,923 

43.0 

1903 

32,839,509 

17,774 

54.1 

1890 

30,245,054 

12,917 

42.7 

1904 

33,016,234 

18,860 

57.1 

1905 

33,193,289 

19,348 

58.3 

1887-1890 

119,719,544 

51,096 

42.7 

1901-1905 

164,281,879 

90,757 

55.2 

1891 

30,455,070 

13,094 

43.0 

1892 

30,665,662 

13,069 

42.6 

1906 

33,325,098 

20,653 

62.0 

1893 

30,875,678 

13,234 

42.9 

1907 

33,514,702 

20,668 

61.7 

1894 

31,085,694 

13,841 

44.5 

1908 

33,826,688 

21,828 

64.5 

1895 

31,295,710 

15,089 

48.2 

1909 

34,077,068 
34,376,609 

21,871 
22,555 

64.2 
65.6 

1910 

18Q1-189'i 

154,377,814 
31,506,302 

68,327 
15,482 

44  3 

1896 

49.1 

1906-1910 

169,120,165 

107,575 

63.6 

1897 

31,716,318 

15,967 

50.3 

1911 

34,688,814 

23,172 

66.8 

1898 

31,926,334 

16,330 

51.1 

1912 

35,026,486 

22,661 

64.7 

1899 

32,136,350 

16,680 

51.9 

1900 

32,340,366 

16,873 

52.2 
50.9 

Source: 

Statistica  dalle  Cause 

di  Morte. 

1896-1900 

159,631,670 

81,332 

688 


APPENDIX  G 

Table  186 

Mortality  from  Cancer  in  Italy,  Males 

1896-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1896 

15,674,385 

6,598 

42.1 

1906 

16,462,598 

8,929 

54.2 

1897 

15,778,868 

6,634 

42.0 

1907 

16,522,748 

9,085 

55.0 

1898 

15,883,351 

6,843 

43.1 

1908 

16,606,874 

9,747 

58.7 

1899 

15,987,834 

6,980 

43.7 

1909 

16,731,840 

9,603 

57.4 

1900 

16,092,317 

7,190 

44.7 
43.1 

1910 
1906-1910 

16,844,538 

9,818 

58.3 

1896-1900 

79,416,755 

34,245 

83,168,598 

47,182 

56.7 

1901 

16,185,335 

7,399 

45.7 

1911 

17,030,126 

10,137 

59.5 

1902 

16,251,656 

7,571 

46.6 

1912 

17,195,903 

10,070 

58.6 

1903 

16,304,816 

7,673 

47.1 

1904 

16,376,052 

8,271 

50.5 

Source: 

Statistica  delle  Cause  di  Morte. 

1905 

16,430,678 

8.417 

51.2 

48.2 

1901-1905 

81,548,537 

39,331 

Table  187 

Mortality  from  Cancer  in  Italy,  Females 

1896-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1896 

15,831,917 

8,884 

56.1 

1906 

16,862,500 

11,724 

69.5 

1897 

15,937,450 

9,333 

58.6 

1907 

16,991,954 

11,583 

68.2 

1898 

16,042,983 

9,487 

59.1 

1908 

17,219,814 

12,081 

70.2 

1899 

16,148,516 

9,700 

60.1 

1909 

17,345,228 

12,268 

70.7 

1900 

16,254,049 

9,683 

59.6 

58.7 

1910 
1906-1910 

17,532,071 

12,737 

72.6 

1896-1900  80,214,915 

47,087 

85,951,567 

60,393 

70.3 

1901 

16,348,002 

9,742 

59.6 

1911 

17,658,688 

13,035 

73.8 

1902 

16,447,854 

10,063 

61.2 

1912 

17,830,583 

12,591 

70.6 

1903 

16,534,693 

10,101 

61.1 

1904 

16,640,182 

10,589 

63.6 

Source: 

Statistica  delle  Cause 

di  Morte. 

1905 

16,762,611 

10,931 

65.2 
62.2 

1901-1905  82,733,342 

51,426 

689 


APPENDIX  G 

Table  188 

Mortality  from  Cancer  in  Italy,  by  Provinces 

1906-1910 


Province  Population 

Piemonte 16,700,015 

Liguria 5,838,536 

Lombardia 23,400,341 

Veneto 17,201,497 

Northern  Italy 63,140,389 

Emilia 13,075,413 

Toscana 13,141,273 

Marche 5,331,467 

Umbria 3,348,323 

Roma 6,351,526 

Central  Italy 41,248,002 

Abruzzi 6,977,124 

Campania 16,151,582 

Puglie 10,388,107 

Bassilicata 2,311,658 

Calabrie 6,837,870 

Sicilia 17,908,500 

Sardegna 4,156,933 

Southern  Italy 64,731,774 

All  Italy 169,120,165 

Source:     Statistica  delle  Cause  di  Morte  neU'amio  1906-1910. 


Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

11,775 

70.5 

4,396 

75.3 

18,987 

81.1 

11,116 

64.6 

46,274 

73.3 

12,118 

92.7 

12,557 

95.6 

3,729 

69.9 

1,973 

58.9 

4,100 

64.6 

34,477 

83.6 

3,244 

46.5 

7,363 

45.6 

4,031 

38.8 

946 

40.9 

2,541 

37.2 

7,354 

41.1 

1,345 

32.4 

26,824 

41.4 

107,575 

63.6 

Table  189 

Mortality  from  Cancer  in  Italy,  by  Organs  and  Parts 

1891-1910 


Deaths  fbom  Cancer 

1891-       1896-       1901-  1906- 

Organ  or  Part                         1895         1900        1905  1910 

Bones  and  joints 306        982     1,998  1,375 

Mouth,  lips, tongue,  palate, 

thyroid,  larynx,  trachea.     2,491     4,777     5,587  4,820 

Stomach  and  oesophagus.  .    19,577  22,756  26,237  33,089 

Liver,  spleen,  pancreas,  in- 
testines and  peritoneum  11,569  15,545  18,256  21,700 

Ner^-ous  system 309        587        448  2,071 

Bladder,  urethra,  prostate, 

penis  and  testicle 1,320     1,502     1,800  2,239 

Breast 4,372    4,590    4,592  5,103 

Uterus,  vagina  and  ovary..   11,654  12,548  12,700  13,741 

Not  specified 16,729  18,045  19,139  23,437 

All  organs 68.327  81,332  90,757  107,575 

Source:     Statistica  delle  Cause  di  Morte,  1891-1910. 


Rate  peb  100,000  Popui^atiojj 

1891-  1896-  1901-  1906- 

1895  1900  1905  1910 

0.20  0.62  1.22  0.81 

1.61  2.99  3.40  2.85 

12.68  14.26  15.97  19.57 

7.49  9.74  11.11  12.83 

0.20  0.37  0.27  1.22 


0.86 

0.94 

1.10 

1.32 

2.83 

2.88 

2.79 

3.02 

7.55 

7.86 

7.73 

8.13 

10.84     11.30     11.65     13.86 
44.26     50.95     55.24     63.62 


690 


APPENDIX  G 


Table  190 
Mortality  from  Cancer  in  Rome,  1898-1912 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 

from 
Cancer 

Rate  per 

100,000 

Population 

1898 

438,417 

347 

79.1 

1906 

502,453 

429 

85.4 

1899 

446,539 

350 

78.4 

1907 

510,387 

494 

96.8 

1900 

454,661 

380 

83.6 

1908 

518,321 

493 

95.1 

1909 

526,255 

534 

101.5 

1901 

462,783 

355 

76.7 

1910 

534,189 

530 

99.2 

1902 

470,717 

425 

90.3 

1903 

478,651 

429 

89.6 

1906-1910 

2,591,605 

2,480 

95.7 

1904 
1905 

486,585 
494,519 

456 
455 

93.7 
92.0 

1911 
1912 

542,123 
550,057 

574 
.548 

105.9 
99.6 

1901-1905 

2,393,255 

2,120 

88.6 

Source : 

Statistica  delle  Cause 

di  Morte, 

Roma. 

Table  191 

Mortality  from  Cancer  in  Naples 

1898-1912 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1898 

554,154 

342 

61.7 

1906 

620,786 

464 

74.7 

1899 

557,616 

318 

57.0 

1907 

632,235 

417 

66.0 

1900 

560,078 

364 

65.0 

1908 

643,684 

453 

70.4 

1909 

655,133 

418 

63.8 

1901 

563,540 

351 

62.3 

1910 

666,582 

411 

61.7 

1902 

574,990 

375 

65.2 

1903 

586,439 

369 

62.9 

1906-1910 

3,218,420 

2,163 

67.2 

1904 
1905 

597,888 
609,337 

401 
336 

67.1 
55.1 

1911 
1912 

678,031 
689,480 

463 
423 

68.3 
61.4 

1901-1905 

2,932,194 

1,832 

62.5 

Source: 

Statistica  delle  Cause 

di  Morte, 

Roma. 

Table  192 

•• 

Mortality  from  Cancer  in 

Genoa 

1898- 

1912 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1898 

226,430 

229 

101.1 

1906 

253,466 

293 

115.6 

1899 

229,190 

200 

87.3 

1907 

257,217 

281 

109.2 

1900 

231,950 

218 

94.0 

1908 

260,968 

273 

104.6 

1909 

264,719 

286 

108.0 

1901 

234,710 

227 

96.7 

1910 

268,470 

271 

100.9 

1902 

238,462 

216 

90.6 

1903 

242,213 

255 

105.3 

1906-1910 

1,304,840 

1.404 

107.6 

1904 
1905 

245,964 
249.715 

240 
220 

97.6 
88.1 

1911 
1912 

272,221 
275,972 

285 
278 

104.7 
100.7 

1901-1905 

1,211,064 

1,158 

95.6 

Source: 

Statistica  delle  Cause 

di  Morte, 

Roma. 

691 


APPENDIX  G 

Table  193 
Mortality  from  Cancer  in  Turin,  1898-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1898 

323,356 

334 

103.3 

1906 

381,381 

398 

104.4 

1899 

327,456 

312 

95.3 

1907 

390,526 

425 

108.8 

1900 

331,556 

343 

103.5 

1908 

399,671 

489 

122.4 

1909 

408,816 

471 

115.2 

1901 

335,656 

364 

108.4 

1910 

417,961 

432 

103.4 

1902 

344,801 

365 

105.9 

1903 

353,946 

347 

98.0 

1906-1910 

1,998,355 

2,215 

110.8 

1904 

363,091 

397 

109.3 

1905 

372,236 

378 

101.5 

1911 

427,106 

462 

108.2 

1912 

436,251 

487 

111.6 

1901-1905 

1,769,730 

1,851 

104.6 

Source: 

Statistica  delle  Cause  di  Morte, 

Roma. 

Table  194 

Mortality  from  Cancer  in  Milan 

1898-1912 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1898 

466,027 

459 

98.5 

1906 

545,330 

658 

120.7 

1899 

474,508 

486 

102.4 

1907 

556,104 

635 

114.2 

1900 

482,989 

483 

100.0 

1908 

566,878 

640 

112.9 

1909 

577,652 

688 

119.1 

1901 

491,460 

466 

94.8 

1910 

588,426 

686 

116.6 

1902 

502,234 

520 

103.5 

1903 

513,008 

513 

100.0 

1906-1910 

2,834,390 

3,307 

116.7 

1904 
1905 

523,782 
534,556 

588 
606 

112.3 
113.4 

1911 
1912 

599,200 
609,974 

812 
736 

135.5 
120.7 

1901-1905 

2,565,040 

2,693 

105.0 

Source: 

Statistica  delle  Cause  di  Morte, 

Roma. 

Table  195 

Mortality  from  Cancer  in  Florence 

1898-1912 


Year 

1898 
1899 
1900 

1901 
1902 
1903 
1904 
1905 

Population 

201,677 
202,981 
204,285 

205,589 
208,317 
211,044 
213,771 
216,498 

Deaths 
from 
Cancer 

301 
278 
313 

287 
327 
292 
293 
340 

Rate  per 

100,000 

Population 

149.2 
137.0 
153.2 

139.6 
157.0 
138.4 
137.1 
157.0 

145.8 

Year 

1906 
1907 
1908 
1909 
1910 

1906-1910 

1911 
1912 

Source: 
Roma. 

Population 

219,225 
221,952 
224,679 
227,406 
230,133 

Deaths 
from 
Cancer 

345 
343 
393 
393 
351 

Rate  per 

100,000 

Population 

157.4 
154.5 
174.9 
172.8 
152.5 

1,123,395         1,825 

232,860            335 
235,587            389 

Statistica  delle  Cause 

162.5 

143.9 
165.1 

1901-1905 

1,055,219 

1,539 

di  Morte, 

APPENDIX  G 

Table  196 
Mortality  from  Cancer  in  Palermo,  1898-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1898 

299,989 

128 

42.7 

1906 

325,393 

159 

48.9 

1899 

303,224 

125 

41.2 

1907 

328,532 

149 

45.4 

1900 

306,459 

140 

45.7 

1908 

331,671 

166 

50.0 

1909 

334,810 

196 

58.5 

1901 

309,694 

129 

41.7 

1910 

337,949 

177 

52.4 

1902 

312,837 

133 

42.5 

1903 

315,976 

138 

43.7 

1906-1910 

1,658,355 

847 

51.1 

1904 

319,115 

125 

39.2 

1905 

322,254 

150 

46.5 

1911 

341,088 

192 

56.3 

1912 

344,227 

161 

46.8 

1901-1905 

1,579,876 

675 

42.7 

Source: 

Statistica  dell 

e  Cause 

di  Morte, 

Roma. 

Table  197 
Mortality  from  Cancer  in  Spain,  1900-1912 


Year 

Population 

Death 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1900 

1901 
1902 
1903 
1904 
1905 

18,566,200 

18,657,000 
18,755,000 
18,853,000 
18,951,000 
19,049,000 

7,294 

7,912 
8,117 
8,315 
8,825 
8,719 

39.3 

42.4 
43.3 
44.1 
46.6 
45.8 

44.4 

1906 
1907 
1908 
1909 
1910 

1906-1910 

1911 
1912 

19,147,000 
19,245,000 
19,343,000 
19,442,000 
19,540,000 

9,113 
9,141 

9,947 

9,914 

10,093 

47.6 
47.5 
51.4 
51.0 
51.7 

96,717,000 

19,640,000 
19,740,000 

48,208 

10,282 
10,899 

49.8 

1901-1905 

94,265,000 

41,888 

52.4 
55.5 

Source :   Annual  Report  of  the  Registrar- 
General  of  Births,  Deaths  and  Marriages 
in  England  and  Wales,  1912. 

Table  198 

Mortality  from  Cancer  in  Spain,  by  Organs  and  Parts 

Urban  and  Rural  Districts,  1900 


ClTIE3 


Organ  or  Part 


Buccal  cavity 

Stomach  and  liver 

Peritoneum,  intestines  and  rectum. 

Female  generative  organs 

Breast 

Other  or  not  specified  organs 


Deaths 
from 
Cancer 

158 
413 
111 
436 
49 
738 


Rate  per 

100,000 

Population 

5.2 
13.6 

3.7 
14.3 

1.6 
24.3 


Rural  Distbicts 

Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

548 

3.5 

1,797 

11.5 

359 

2.3 

654 

4.2 

183 

1.2 

1,848 

11.9 

5,389 


34.0 


All  organs 1,905  62.7 

Population:  Cities,  3,039,055,  Rural  Districts,  15,568,619. 

Source:     Dr.  Hans  Leyden.     Bericht   iiber  die  am  1.  September    1902  in  Spanien 
veranstaltete  Krebssammelforschung.     In:  Zeitschrif t  f iir  Krebsforschung,  1.  Band,  1904. 


693 


APPENDIX  G 

Table  198a 
Mortality  from  Cancer  in  Spain,  by  Organs  and  Parts,  according  to  Sex 

1901-1905 


Organ  or  Part 

Buccal  cavity 

Stomach  and  liver 

Peritoneum,  intestines,  rectum. 

Female  generative  organs 

Breast 

Skin 

Other  or  not  specified  organs .  . 


AH  organs. 


18,480 


40. 


Males 

Females 

Deaths 

Rate  per 

Deaths 

Rate  per 

from 

100,000 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1,189 

2.6 

286 

0.6 

7,719 

16.9 

5,809 

12.0 

974 

2.1 

1,221 

2.5 

6,100 

12.6 

1,548 

3.2 

1,053 

2.3 

817 

1.7 

7,545 

16.5 

7,633 

15.7 

23,414 


48.2 


Source:     La  Geografia  Medica  de  la  Peninsula  Iberica  por  el  Dr.  Ph.  Hauser.  Madrid, 
1913. 


Table  199 

Table  200 

Mortality  from  Cancer  in  the  City 

Mortality  from  Cancer  in  Portugal 

of  Madrid,  19 

01-1910 

Deaths 

Rate  per 

1902-1910 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1901 

543,005 

425 

78.3 

1902 

5,520,378 

1,252 

22.7 

1902 

546,175 

474 

86.8 

1903 

5,569,001 

1,306 

23.5 

1903 

549,345 

500 

91.0 

1904 

5,617,624 

1,320 

23.5 

1904 

552,515 

491 

88.9 

1905 

5,666,247 

1,261 

22.3 

1905 

555,685 

505 

90.9 

1902-1905 

22,373,250 

5,139 

23.0 

1901-1905 

2,746,725 

2,395 

87.2 

1906 

5,714,870 

1,284 

22.5 

1906 

558,855 

500 

89.5 

1907 

5,763,493 

1,246 

21.6 

1907 

562,026 

524 

93.2 

1908 

5,812,116 

1,304 

22.4 

1908 

565,197 

555 

98.2 

1909 

5,860,739 

1,324 

22.6 

1909 

568,368 

559 

98.4 

1910 

5,909,362 

1,346 

22.8 

1910 

571,539 

535 

93.6 

6,504 

22.4 

1906-1910 

2,825,985 

2,673 

94.6 

Source: 

Annuario  Estatistico  de  Portu- 

Source: 

Ayuntamiento    de 

Madrid. 

gal,  1902-1905. 

Estadistica  Demografica 

1901-1910. 

Letter  from  Institute  Central  de  Higiene, 

Lisboa. 

Note: 

Includes  Madeira  and  the  Azores. 

694 


APPENDIX  G 

Table  201 

Mortality  from  Cancer  in  Portugal,  by  Sex 

1902-1910 


MALES 

FEMALES 

Deaths 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1902 

2,619,971 

547 

20.9 

1902 

2,900,407 

705 

24.3 

1903 

2,643,048 

527 

19.9 

1903 

2,925,953 

779 

26.6 

1904 

2,666,124 

553 

20.7 

1904 

2,951,500 

767 

26.0 

1905 

2,689,201 

525 

19.5 
20.3 

1905 
1902-1905 

2,977,046 

736 

24.7 

1902-1905 

10,618,344 

2,152 

11,754,906 

2,987 

25.4 

1906 

2,711,706 

493 

18.2 

1906 

3,003,164 

791 

26.3 

1907 

2,734,777 

526 

19.2 

1907 

3,028,716 

720 

23.8 

1908 

2,757,849 

573 

20.8 

1908 

3,054,267 

731 

23.9 

1909 

2,780,921 

548 

19.7 

1909 

3,079,818 

776 

25.2 

1910 

2,803,992 

575 

20.5 
19.7 

1910 
1906-1910 

3,105,370 

771 

24.8 

1906-1910 

13,789,245 

2,715 

15,271,335 

3,789 

24.8 

Source: 

Annuario  Estatistico  de  Portu- 

gal,  1902-1905. 

Letter  from  Institute  Central  de  Higiene, 

Lisboa. 

Note :    Includes  Madeira  and  the  Azores. 

Table  202 

Mortality  from  Cancer  in  Portugal 

by  Provinces,  1906-1910 


Province  Population 

Entre  Minho-e-Douro 6,286,343 

Tras-os-Montes 2,174,830 

Beira 7,981,530 

Estremadura 6,910,930 

Alemtejo 2,307,725 

Algarve 1,344,795 

Azores 1,231,717 

Madeira '. 822,710 

Total 29,060,580 

Source:     Letter  from  Instituto  Central  de  Higiene,  Lisboa. 


Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

1,222 

19.4 

164 

7.5 

890 

11.2 

2,666 

38.6 

489 

21.2 

236 

17.5 

427 

34.7 

410 

49.8 

6,504 


22.4 


695 


APPENDIX  Q 

Table  203 

Cancer  Census  of  Portugal,  by  Organs  and  Parts 

1904 


Number  op 

Cases 

Percentage 

Organ  or  Fart 

Total 

Males 

Females 

Total 

Males 

Females 

Skin 

224 

100 

124 

18.9 

22.4 

16.7 

Lips 

149 

129 

20 

12.5 

28.9 

2.7 

Tongue 

Stomach 

29 
104 

23 
70 

6 
34 

2.4 

8.8 

5.1 
15.7 

0.8 
4.6 

Other  digestive  organs 
Male  generative  organs 
Breast 

68 

43 

305 

42 
43 

26 
305 

5.7 

3.6 

25.7 

9.4 
9.6 

3.5 
41.2 

Uterus 

159 

159 

13.4 

21.5 

Other  female  generative 

organs 

Other  organs 

Not  specified 

26 

74 
7 

38 

2 

447 

26 

36 

5 

741 

2.2 
6.2 
0.6 

8.5 
0.4 

100.0 

3.5 

4.8 
0.7 

1,188 

100.0 

100.0 

Source:  Dr.  Azevedo  Neves:  Bericht  iiber  die  Zahlung  der  im  Mai  und  Juni  1904 
in  Portugal  in  arztlicher  Behandlung  gewesenen  Krebskranken.  In:  Zeitschrift  fiir 
Krebsforschung,  7.  Band. 

Note:    Of  1,739  physicians,  1,307  made  reply  to  the  circular  of  inquiry. 


Table  204 

Mortality  from  Cancer  in  Porto 

1893-1910 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1893 

147,590 

88 

59.6 

1906 

180,938 

104 

57.4 

1894 

150,500 

88 

58.5 

1907 

183,352 

119 

64.9 

1895 

153,410 

119 

77.6 

1908 

185,766 

101 

54.4 

1909 

188,180 

118 

62.7 

1896 
1897 

156,319 
159,228 

96 

77 

61.4 

48.4 

1910 

190,594 

141 

74.0 

1898 

162,137 

119 

73.4 

1906-1910 

928,830 

583 

62.8 

1899 

164,040 

97 

59.1 

1900 

166,454 

96 

57.7 

Source: 

Annuario  Estatistico  de  Portu- 

gal,  -1902-1905. 

Zeitschrift  fiir  Krebs 

1896-1900 

808,178 

485 

60.0 

forschung 

7.  Band. 

Letter  from  Institute  Central  de  Higiene, 

1901 

168,868 

100 

59.2 

Lisboa. 

1902 

171,282 

97 

56.6 

1903 

173,696 

106 

61.0 

1904 

176,110 

109 

61.9 

1905 

178,524 

126 
'      538 

70.6 
61.9 

1901-1905 

868,480 

APPENDIX  G 


Table  205 

Table  206 

Mortality  from  Cancer  in 

Lisbon 

Mortality  from  Cancer  in  Moscow 

1902-19 

10 

Deaths 

Rate  per 

by  Sex, 1892-1910 
TOTAL 

Year 

Population 

from 
Cancer 

100,000 
Population 

Average  No. 
Averai?e           of  Deaths 

Rate  per 

100,000 

1902 

367,430 

294 

80.0 

Years 

Population      from  Cancer 

Population 

1903 

374,644 

277 

73.9 

1892-1896 

960,000 

763 

79.5 

1904 

381,858 

312 

81.7 

1897-1901 

1,098,000 

861 

78.4 

1905 

389,072 

268 

68.9 

1902-1905 
1906-1910 

1,251,000 
1,410,000 

994 
1,161 

79.5 

82.3 

1902-1905 

1,513,004 

1,151 

76.1 

RLVLES 

1906 

396,286 

308 

77.7 

1892-1896 

550,000 

3ie 

57.5 

1907 

403,500 

309 

76.6 

1897-1901 

624,000 

361 

57.9 

1908 

410,714 

350 

85.2 

1902-1905 

702,000 

453 

64.5 

1909 

417,928 

365 

87.3 

1906-1910 

785,000 

530 

67.5 

1910 

425,142 

350 

82.3 

81.9 

1892-1896 

FEMALES 
410,000            447 

1900-1910 

2,053,570 

1,682 

109.0 

1897-1901 

474,000 

500 

105.5 

Source: 

Annuario    Estatistico  de  Por- 

1902-1905 

549,000 

541 

98.5 

tugal. 

1906-1910 

625,000 

631 

101.0 

Letter  from  Institute  Central  de  Higiene, 

Lisboa. 

Source : 

Annuaire  Statistique  de  la  ville 

de  Moscou 

Deuxieme 

Annee,  1907-1908. 

Table  207 

Table  208 

Mortality  from  Cancer  in 

Moscow 

Mortality  from  Cancer  in  Petrograd 

1910-19 

12 

Deaths 

Rate  per 

1911-19] 

12 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1910 

1,514,595 

1,415 

93.4 

1911 

1,935,430 

1,607 

83.0 

1911 

1,566,164 

1,478 

94.4 

1912 

1,990,874 

1,753 

88.1 

1912 

1,617,733 

1,559 

96.4 

1911-1912 

3,926,304 

3,360 

85.6 

1910-1912 

4,698,492 

4,452 

94.8 

Source: 

Releve    succint    des 

donnees 

Source: 

Bulletin  recapitulatif  de  la  \'ille 

statistiques 

sur  la  ville  de  Petrograd  pour 

de  Moscou  public  par 

le  Bureau   de  la 

les  annees 

1911  et  1912. 

Statistique  Municipale. 

Annee, 

1912. 

Note:     With    suburbs 

;     includes     only 

carcinoma. 

697 


APPENDIX  G 


Table  208a 

Mortality  from  Cancer  in  the  City 

of  Warsaw,  1881-1912 


Year 

1881 
1882 
1883 
1884 
1885 


Population 

379,763 
382,964 
391,491 
404,889 
406,965 


1886 
1887 
1888 
1889 
1890 


431,864 
439,174 
444,814 
445,770 
455,852 


1886-1890  2,217,474 


1891 
1892 
1893 
1894 
1895 


465,272 
490,417 
501,021 
515,654 
535,968 


1896 
1897 
1898 
1899 
1900 


553,643 
638,209 
654,942 
671,675 
688,408 


1901 
1902 
1903 
1904 
1905 


705,141 

721,874 
736,607 
755,340 

772,074 


1906 
1907 
1908 
1909 
1910 


783,808 
805,542 
822,276 
839,010 
855,744 


1911  872,478 

1912  889,222 


Deaths 
from 
Cancer 

153 

232 
221 
276 
268 


1881-1885  1,966,072    1,150 


260 
308 
247 
292 
281 


1,388 

313 
370 
318 
332 
366 


1891-1895     2,508,332         1,699 


407 
424 
443 

417 
466 


1896-1900     3,206,877         2,157 


464 
523 
560 
483 
532 


1901-1905     3,691,036         2,562 


500 
548 
571 
575 

547 


1906-1910     4,106,380         2,741 


649 
643 


Rate  per 

100,000 

Population 

40.3 
60.6 
56.5 
68.2 
65.9 

58.5 

60.2 
70.1 
55.5 
65.5 
61.6 

62.6 

67.3 
75.4 
63.5 
64.4 
68.3 

67.7 

73.5 
66.4 
67.6 
62.1 

67.7 

67.3 

65.8 
72.5 
76.0 
63.9 
68.9 

69.4 

63.8 
68.0 
69.4 
68.5 
63.9 

66.7 

74.4 
72.3 


Source:  Statistique  Demographique  des 
Grandes  Villes  du  Monde  pendant  les 
annees  1880-1909.  Amsterdam,  1911.  1910- 
1912,  Reports  of  the  Highest  Medical  In- 
spector for  Russia. 


Table  209 

Mortality  from  Cancer  in  Serbia 

1892-1912 


Year 

1892 
1893 
1894 
1895 


Population 

2,211,606 
2,240,270 
2,272,992 
2,312,484 


1892-1895  9,037,352 


1896 
1897 
1898 
1899 
1900 


2,345,837 
2,384,205 
2,413,694 
2,450,392 

2,492,882 


1896-1900  12,087,010 


1901 
1902 
1903 
1904 
1905 


2,535,956 
2,576,517 
2,621,576 
2,671,505 
2,688,747 


Deaths 
from 
Cancer 

121 
140 
156 
128 

545 

154 
167 
178 
233 
235 

967 

230 
248 
238 
275 
279 


1901-1905  13,094,301    1,270 


1906 
1907 
1908 
1909 
1910 


2,735,147 
2,784,036 
2,821,015 
2,847,891 
2,911,701 


371 
355 
374 
373 


1906-1910  14,099,790         1,763 


1911 
1912 


2,960,000 
3,002,000 


394 

375 


Rate  per 

100,000 

Population 

5.5 
6.2 
6.9 
5.5 

6.0 

6.6 
7.0 
7.4 
9.5 
9.4 

8.0 

9.1 

9.6 

9.1 

10.3 

10.4 

9.7 

10.6 
13.3 
12.6 
13.1 

12.8 

12.5 

13.3 
12.5 


Source:  Annuaire  statistique  du  roy- 
aume  de  Serbie,  1896-1906. 

Original  data  furnished  by  the  Statistical 
OflSce  of  Serbia. 


698 


APPENDIX  G 


Table  210 

Table  211 

Mortalit 

y  from  Cancer 

in  the  Cities 

Mortality  from  Cancer  in 

Twelve 

of  Serbia,  1907 

-1912 

eaths 

Rate  per 

Citii 

2S  of  Greece, 

1900- 

Deaths 

1908 

D 

Rate  per 

Year 

Population            f 

rom 

100,000 

Year 

Population 

from 

100,000 

c 

ancer 

Population 

Cancer 

Population 

1907 

426,300 

159 

37.3 

1900 

391,158 

143 

36.6 

1908 

437,000 

149 

34.1 

1909 

447,700 

173 

38.6 

1901 

396,554 

179 

45.1 

1910 

458,400 

172 

37.5 

1902 

401,950 

176 

43.8 

1911 

469,100 

168 

35.8 

1903 

407,346 

210 

51.6 

1912 

479,800 

156 

32.5 

1904 

412,742 

185 

44.8 

1905 

418,138 

207 

49.5 

1907-1912 

2,718,300 

977 

35.9 

1901-1905 

2,036,730 

957 

47.0 

Source: 

Letter    from 

the 

Statistical 

Office  of  Serbia. 

1906 

423,534 

228 

53.8 

1907 

428,930 

228 

53.2 

1908 

434,326 

252 

58.0 

Source: 

Bulletin  annuel  des  deces  de  12 

villesde  Grece,  1900-1908 

Table  212 

Cases  of  Cancer  in  Twelve  Cities  of  Greece,  by  Organs  and  Parts 

according  to  Sex,  1905-1908 


NtTMBER  OP  Cases 

Percentage 

Organ  or  Part 

Total 

Males 

Females 

Total 

Males 

Females 

Skin 

65 

49 

16 

9.8 

14.3 

5.0 

Lips 

53 

39 

14 

8.0 

11.4 

4.4 

Tongue 

41 

31 

10 

6.2 

9.1 

3.2 

Thyroid  gland 

Brain 

1 

1 

1 
1 

0.2 
0.2 

0.3 
0.3 

Larynx 

Branchiae 

9 
1 

9 

1 

1.4 
0.2 

2.6 
0.3 

Lungs 

(Esophagus 

Stomach 

1 

8 
159 

1 

8 
117 

42 

0.2 

1.2 

24.1 

0.3 

2.3 

34.2 

13.2 

Intestines 

33 

28 

5 

5.0 

8.2 

1.6 

Pancreas 

22 

18 

4 

3.3 

5.3 

1.3 

Liver 

14 

13 

1 

2.1 

3.8 

0.3 

Peritoneum 

1 

1 

0.2 

0.3 

Kidney 

Bladder 

7 
18 

6 

18 

1 

1.1 

2.7 

1.7 
5.3 

0.3 

Breast 

79 

79 

12.0 

24.8 

Penis 

1 

i 

0.2 

0.3 

Uterus 

112 

112 

17.0 

35.2 

Ovaries 

9 

9 

1.4 

2.8 

Vagina 

25 

25 

3.8 

7.9 

660 


342 


318 


100.0 


100.0 


100.0 


All  specified  organs. . . . 

Source:     Dr.  S.  A.  Gavales:     Die  Verbreitung  der  Krebskrankheit  in  Griechenland. 
In:     Zeitschrift  fiir  Krebsforschung,  7.  Band. 


699 


APPENDIX  G 

Table  213 

Mortality  from  Cancer  in  Athens,  by  Sex 

1900-1908 


TOTAL 

JIALES 

Year 
1900 

Population 
138,570 

Deaths 
from 
Cancer 

68 

Rate  per 

100,000 

Population 

49.1 

Year 
1900 

Population 
74,232 

Deaths 
from 
Cancer 

32 

Rate  per 

100,000 

Population 

43.1 

1901 
1902 
1903 
1904 
1905 

142,700 
146,830 
150,960 
155,090 
159,220 

76 

75 

88 

103 

108 

450 

53.3 
51.1 

58.3 
66.4 
67.8 

59.6 

1901 
1902 
1903 
1904 
1905 

1901-1905 

76,444 
78,657 
80,869 
83,082 
85,294 

35 
46 
48 
53 
57 

239 

45.8 
58.5 
59.4 
63.8 
66.8 

1901-1905 

754,800 

404,346 

59.1 

1906 
1907 
1908 

163,350 
167,480 
171,610 

109 
107 
116 

66.7 
63.9 
67.6 

1906 
1907 
1908 

87,507 
89,719 
91,931 

58 
48 
55 

66.3 
53.5 
69.8 

FEMALES 

Year 
1900 

Population 

64,338 

Deaths 
from 
Cancer 

36 

Rate  per 

100,000 

Population 

56.0 

1901 
1902 
1903 
1904 
1905 

66,256 

68,173 
70,091 
72,008 
73,926 

41 
29 
40 
50 
51 

211 

61.9 
42.5 
57.1 
69.4 
69.0 

1901-1905 

350,454 

60.2 

1906 
1907 
1908 

75,843 
77,761 
79,679 

51 
59 
61 

67.2 
75.9 
76.6 

Source:      Bulletin  annuel  des  deces  de  12 
villes  de  Grece. 


700 


APPENDIX  G 

Table  214 

Mortality  from  Cancer  in  the  Cities  of  Roumania 

1901-1912 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1901 
1902 
1903 

1,156,636 
1,172,318 
1,188,000 

749 

748 
833 

64.8 
63.8 
70.1 

66.3 

1906 
1907 
1908 
1909 
1910 

1906-1910 

1,235,046 
1,250,728 
1,266,409 
1,282,090 
1,297,771 

788 
709 
818 
765 
835 

63.8 
56.7 
64.6 
59.7 
64.3 

1901-1903 

3,516,954 

2,330 

6,332,044 

3,915 

61.8 

1911 
1912 

1,313,452 
1,329,133 

813 
938 

61.9 
70.6 

Source:  Anuarul  Statistic  al  Romaniei, 
1912. 

Annual  Report  of  the  Registrar-Gen- 
eral of  Births,  Marriages  and  Deaths  in 
England  and  Wales,  1912. 

Table  215 

Mortality  from  Cancer  in  Constantinople 

1908-1912 


Deaths  Rate  per 

Year                                                                                          Population                       from  100,000 

Cancer  Population 

1908 1,100,000                     370  33.6 

1909 1,125,000                     391  34.8 

1910 1,150,000                     437  38.0 

1911 1,175,000                     429.  36.5 

1912 1,200,000                      374  31.2 

1908-1912 5,750,000                  2,001  34.8 

Source:     Statistique  Sanitaire  de  la  ville  de  Constantinople.     Annees  1324  a  1328. 

Table  216 

Mortality  from  Cancer  in  Constantinople,  by  Religion 

1908-1912 

Deaths  Rate  per 

Total                           from  100,000 

Population                      Cancer  Population 

Mohammedans 3,460,000                     782  22.6 

Greeks 1,174,000                     659  56.1 

Armenians 532,000                     294  65.3 

Jews 278,000                      123  44.2 

Others 306,000                      143  46.7 

Total 5,750,000                  2.001  S4.8 

Source:    Statistique  Sanitaire  de  la  ville  de  Constantinople.     Annees  1324  a  1328. 


701 


APPENDIX  G 

Table  217 
Mortality  from  Cancer  in  Countries  of  Africa 


Deaths  Rate  per 

Population  from  100,000 

Cancer  Population 

Algeria 3,688,433  1,257  34.1 

Cape  Colony 1,898,895  1,067  56.2 

Mauritius 1,843,819  171  9.3 

Natal 1,111,756  366  32.9 

Sierra  Leone 68,218  9  13.2 

Transvaal 430,745  148  34.4 

Total 9,041,866  3,018  33.4 

Population,  1911:  1,959,645. 

Note:  The  data  are  given  for  Algeria,  1908-1912,  Europeans  only;  for  Cape  Colony, 
1904-1908,  twenty-five  cities  and  towns;  for  Mauritius,  1906-1910;  for  Natal,  1908-1912, 
Europeans  and  East  Indians;  for  Sierra  Leone,  1910-1911,  City  of  Freetown  only;  for 
Transvaal,  1909-1911,  Johannesburg  only. 

Table  218 
Mortality  from  Cancer  in  Algeria 
European  Population,  1904-1912 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1904 
1905 

664,674 
672,467 

196 

247 

29.5 
36.7 

1906 
1907 
1908 
1909 
1910 

680,259 
694,616 
708,973 
723,330 
737,687 

227 
170 
196 
188 
239 

33.4 
24.5 
27.6 
26.0 
32.4 

06-1910 

3,544,865 

1,020 

28.8 

1911 
1912 

752,043 
766,400 

279 
355 

37.1 
46.3 

Source:     Statistique  generale  de  I'Algerie. 


702 


APPENDIX  G 

Table  219 
Mortality  from  Cancer  in  Mauritius,  1898-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1898 

368,665 

29 

7.9 

1906 

368,745 

35 

9.5 

1899 

368,675 

50 

13.6 

1907 

368,755 

29 

7.9 

1900 

368,685 

44 

11.9 

1908 

368,764 

36 

9.8 

1909 

368,773 

44 

11.9 

1901 

368,695 

62 

16.8 

1910 

368,782 

27 

7.3 

1902 

368,705 

59 

16.0 

1903 

368,715 

50 

13.6 

1906-1910 

1,843,819 

171 

9.3 

1904 

368,725 

42 

11.4 

1905 

368,735 

52 

14.1 

1911 

368,791 

50 

13.6 

1912 

368,800 
Colony  of 

36 

9  8 

1901-1905 

1,843,575 

265 

14.4 

Source: 

Mauritius 

,  Annual 

Reports  of  the  Registrar-General  < 

an  Births, 

Deaths  and  Marriages. 

Table  220 

Mortality  from  Cancer  in  Mauritius 

Cases  Treated  in  Public  Hospitals 

1898-1908 


Fatality 

Fatality 

Year 

Cases 

Deaths 

Per  Cent. 

Year                         Cases           Deaths       Per  Cent. 

1898 

22 

5 

22.7 

1906                     68                9            13.2 

1899 

46 

8 

17.4 

1907                     57              10            17.5 

1900 

41 

11 

26.8 

1908                     57              11            19.3 

1901 

60 

18 

30.0 

1902 

47 

5 

10.6 

Source:     Colony  of  Mauritius,    Annual 

1903 

64 

20 

31.3 

Reports  on  the  Medical  and  Health  Depart- 

1904 

50 

11 

22.0 

ment. 

1905 

83 

11 

13.3 

Table  221 

Mortality  from  Cancer  in  the  Union  of  South  Africa,  by  Organs  and  Parts 

according  to  Sex,  White 

1912 


Males 


Organ  or  Part 

Buccal  cavity 

Stomach  and  liver 

Peritoneum,  intestines,  rectum. , 

Female  generative  organs 

Breast    

Skin 

Other  or  not  specified  organs  .  . . 


All  organs 188 


Deaths 

from 

Cancer 

Rate  per 

100,000 

Population 

19 
90 
18 

4.8 

22.7 

4.6 

2 
59 

0.5 
14.9 

47.5 


Females 

Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

1 

0.3 

32 

9.8 

14 

4..S 

28 

8.6 

19 

5.8 

4 

1.2 

26 

8.0 

124 


38.0 


Source:    Statistical  Year-Book  of  the  Union  of  South  Africa,  1913. 
Note:    The  data  include  Natal,  Transvaal  and  Orange  Free  State  only. 


703 


APPENDIX  G 

Table  222 

Mortality  from  Cancer  in  the  Union  of  South  Africa 

by  Provinces,  White 

1912 

Deaths  Rate  per 

White  from  100,000 

Population  Cancer  Population 

NataJ 98,294  61  62.1 

Transvaal 442,577  175  39.5 

Orange  Free  State 180,994  76  42.0 

Total 721,865  312  43.2 

Source:     Statistical  Year-Book  of  the  Union  of  South  Africa,  1913. 


Table  223 

Mortality  from  Cancer  in  Cape  Colony,  South  Africa 

Twenty-five  Cities  and  Towns 

1900-1908 


Deaths 

Rate  per 

Deaths         Rate  per 

Year 

Population 

from 
Cancer 

100,000 
Population 

Year 

Population 

from            100,000 
Cancer       Population 

1900 

334,441 

200 

59.8 

1906 
1907 

379,779 
376,532 

236            62.1 
186            49.4 

1901 

347,399 

190 

54.7 

1908 

373,285 

228            61.1 

1902 

360,357 

218 

60.5 

1903 

373,315 

185 

49.6 

Source: 

Vital  Statistics  of  South  Africa, 

1904 

386,273 

193 

50.0 

1900-1905. 

Health  Reports  of  South  Africa, 

1905 

383,026 

224 

58.5 
54.6 

1906-1908. 

1901-1905 

1,850,370 

1,010 

Table  224 
Mortality  from  Cancer  in  Johannesburg,  South  Africa,  by  Race 

1909-1911 


Race  Population 

European 219,530 

Asiatic 10,754 

Native  Black 200,461 

Total 430,745 


Deaths 

from 

Cancer 

114 
5 


148 


Rate  per 

100,000 

Population 

51.9 
46.5 
14.5 

34.4 


Source:  Report  of  the  Medical  Officer  of  Health  on  the  Public  Health  and  Sanitary 
Circumstances  of  Johannesburg  during  the  two  years  1st  July,  1909,  to  30th  June,  1911. 

Note:  According  to  the  returns  of  the  Transvaal  Chamber  of  Mines,  out  of  3,082 
deaths  from  all  causes  among  the  native  laborers  on  the  Rand,  only  five  deaths,  or  0. 2 
per  cent.,  were  attributed  to  malignant  disease.  Practically  all  of  the  deaths  were 
medically  certified. 


704 


APPENDIX  G 

Table  225 

Mortality  from.  Cancer  in  Natal,  South  Africa 

European  Population,  1902-1912 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1902 

74,600 

40 

53.6 

1906 

101,314 

45 

44.4 

1903 

92,000 

30 

32.6 

1907 

99,150 

57 

57.5 

190i 

101,183 

49 

48.4 

1908 

99,745 

53 

53.1 

1905 

101,170 

34 

33.6 

1909 

98,934 

64 

64.7 

1910 

98,758 

58 

58.7 

1902-1905 

368,953 

153 

41.5 

1906-1910 

497,901 

277 

55.6 

1911 

98,582 

63 

63.9 

1912 

98,406 

61 

62.0 

Source:     Colony  of 
the  Health  Officer. 

Natal,   Reports  of 

Table  226 

Mortality  from  Cancer  in  Natal,  South  Africa 

East  Indians,  1903-1912 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1903 

86,000 

10 

11.6 

1906 

98,049 

5 

5.1 

1904 

84,500 

8 

9.5 

1907 

101,078 

14 

13.9 

1905 

91,239 

5 

5.5 

1908 

104,120 

13 

12.5 

— 

1909 

103,906 

15 

14.4 

1903-1905 

261,739 

23 

8.8 

1910 
1906-1910 

122,737 

13 
60 

10.6 

529,890 

11.3 

1911 

141,568 

11 

7.8 

1912 

145,000 

15 

10.3 

Source:     Colony  of  Natal, 
the  Health  Officer. 

[leports  of 

Table  227 
Cases  of  Cancer  in  the  Colonial 
Hospital,  Sierra  Leone,  1870-1909 


Years 

Total 
Admissions 

Cases  of 
Cancer 

Rate  per 

1,000 

Admissions 

1870-1879 

6,509 

4 

0.6 

1880-1889 

5,334 

6 

1.1 

1890-1899 

10,610 

10 

0.9 

1900-1909 

10,163 

26 

2.6 

Source:     Sierra  Leone,    Annual  Reports 
on  the  Medical  Department. 


705 


APPENDIX  G 

Table  228 
Cases  of  Cancer  in  the  Colonial  Hospital,  Sierra  Leone,  by  Organs  and  Parts 

1900-1909 


Organ  or  Part  No.  of  Cases 

Carcinoma  of  oesophagus 1 

Carcinoma  of  rectum 3 

Carcinoma  of  uterus 3 

Carcinoma  of  breast 10 

Adenosarcoma  of  breast 1 

Adenosarcoma  of  groin 1 

Mellanotic  sarcoma  of  foot 1 

Sarcoma  of  shovdder  joint 1 

Sarcoma  of  arm 1 

Sarcoma  of  eye 1 

Chondrosarcoma  of  upper  jaw 1 

Epithelioma  of  tongue 1 

Papilloma  of  bladder 1 

All  organs 26 

Source:     Sierra  Leone,  Annual  Reports  on  the  Medical  Department. 


Per  Cent. 
3.8 
11.5 
11.5 

38.5 

3.8 
3.8 
3.8 
3.8 
3.8 
3.8 
3.8 
3.8 
3.8 


100.0 


Table  229 

Mortality  from  Cancer  in  the  City  of 

Freetown,  Sierra  Leone,  1910-1911 


Year 

1910 
1911 

Population 

34,128 
34,090 

Deaths 
from 
Cancer 

3 
6 

9 

Rate  per 

100,000 
Population 

8.8 
17.6 

1910-1911 

68,218 

13.2 

Soiu'ce:    Sierra  Leone,    Annual  Reports 
on  the  Medical  Department. 


Table  230 

Cases  of  Tumor  Treated  in  Hospital  Da  Praia 

Cape  Verde  Islands,  by  Race 

1892-1904 


White 

Black 

Mulatto 

Total 

Males      Females 

Males       Females 

Males      Females 

Males  Females 

Cancer 

Sarcoma 

Other  tumors .  .  . 

...    2         i 

7             5 
4 

4 

17           11 
3            4 
3           11 

24           16 
5             9 
3           15 

All  tmnors 

...     2             1 

7           13 

23           26 

32           40 

3 

20 

49 

72 

In  1904,  seven  persons  were  under  treatment  for  cancer  in  the  hospital  of  St.  Vincente, 
Cape  Verde  Islands,  two  males  and  five  females: 

Males  Females 

1  Cancer  of  pleura  2  Cancer  of  lips 

1  Cancer  of  intestines  2  Cancer  of  breast 

1  Cancer  of  uterus 


706 


APPENDIX  G 

Table  231 

Cases  of  Cancer  Treated  in  Hospital  da  Praia,  Cape  Verde  Islands,  by 

Organs  and  Parts,  according  to  Race  and  Sex,  1892-1904 


Organ  or  Part 

Males 

Black 
Fem 

lies 

i 

3 

1 

5 

Mulatto 
Males      Fer 

1 
3 
1 

i 

ii 

17 

nales 
1 

Eye 

1 

Extremities 

1 

1 

Lips       

Tongue 

1 

9. 

Rectum 

Anus   ...             

1 

Breast 

3 

Ovaries 

1 

Uterus 

9, 

Vagina 

Penis 

4 

All  organs 

7 

11 

12 

28 

Note:  In  the  colony  of  the  Cape  Verde  Islands  and  Guinea  cancer  is  believed  to  be 
quite  common  among  the  colored  population. 

In  the  colony  of  St.  Thomas  and  Principe  there  has  been  found  only  one  case  of  cancer 
among  the  colored  population  (cancer  uteri,  black  woman,  40  years  of  age). 

In  Angola  cancer  is  very  rare,  only  one  case  is  known  (cancer  mammae,  black  woman, 
28  years  of  age). 

In  Mosambique  cancer  has  never  been  found  among  the  colored  population. 

In  Portuguese  India  cancer  seems  to  be  quite  common,  especially  in  Goa,  but  the  sta- 
tistical data  are  very  incomplete. 

Macao  (Portuguese  China).  Cancer  is  rare.  No  cases  in  1904.  One  man  died  from 
cancer  of  pharynx  in  1900;  one  woman  died,  1895,  from  cancer  uteri  spreading  to  rectum 
and  vesica  urinaria;  one  woman  died  (year  unknown)  from  cancer  uteri  spreading  to  vesica 
urinaria. 


707 


APPENDIX  G 

Table  232 
Mortality  from  Cancer  in  the  Countries  of  Asia 


Deaths  Rate  per 

Population  from  100,000 

Cancer  Population 

Ceylon    20,076,320  1,133  5.6 

Hongkong 1,737,310  140  8.1 

India    4,456,200  522  11.7 

Japan 242,460,425  145,965  60.2 

Penang 1,391,089  143  10.3 

Philippine  Islands 1,190,154  325  27.3 

Shanghai 68,684  38  55.3 

Singapore 1,434,780  181  12.6 

Total 272,814,962  148,447  54.4 

Population,  1911:  57,820,460. 

Note:  The  data  are  given  for  Ceylon,  1907-1911;  for  Hongkong,  1907-1911;  for 
India,  City  of  Calcutta,  1908-1912;  ior  Japan,  1905-1909;  for  Penang,  1909-1913;  for 
Philippine  Islands,  City  of  Manila,  1909-1913;  for  Shanghai,  1909-1913,  Europeans  only; 
for  Singapore,  1906-1910. 


Table  233 

Mortality  from  Cancer  in  the  City  of  Calcutta,  India 

1881-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

433,219 

54 

12.5 

1901 

847,796 

82 

9.7 

1882 

458,053 

44 

9.6 

1902 

852,624 

91 

10.7 

1883 

482,887 

43 

8.9 

1903 

857,451 

90 

10.5 

1884 

507,721 

31 

6.1 

1904 

862,278 

99 

11.5 

1885 

532,555 

55 

10.3 
9.4 

1905 
1901-1905 

867,105 

78 
440 

9.0 

1881-1885 

2,414,435 

4,287,254 

10.3 

1886 

557,389 

54 

9.7 

1906 

871,932 

94 

10.8 

1887 

582,223 

45 

7.7 

1907 

876,759 

96 

10.9 

1888 

607,057 

63 

10.4 

1908 

881,586 

114 

12.9 

1889 

631,891 

60 

9.5 

1909 

886,413 

80 

9.0 

1890 

656,725 

64 

286 

9.7 
9.4 

1910 
1906-1910 

891,240 

105 

489 

11.8 

1886-1890 

3,035,285 

4,407,930 

11.1 

1891 

681,560 

65 

9.5 

1911 

896,067 

98 

10.9 

1892 

698,184 

68 

9.7 

1912 

900,894 

125 

13.9 

1893 

714,808 

73 

10.2 

1913 

905,721 

110 

12.1 

1894 

731,432 

71 

9.7 

1895 

748,056 

69 

9.2 

Source: 

Report  of  the  Health  Officer  of 

Calcutta. 

1891-1895 

3,574,040 

346 

9.7 

Note:  Without  suburbs. 

1896 

764,680 

57 

7.5 

1897 

781,304 

51 

6.5 

1898 

797,927 

64 

8.0 

1899 

814,550 

79 

9.7 

-' 

1900 

831,173 

72 
323 

8.7 
8.1 

1896-1900 

3,989,634 

708 


APPENDIX  G 

Table  234 
Mortality  from  Cancer  in  the  Hospitals  in  the  Province  of  Bengal,  India 

1911-1912 


HOSPITALS  IN  CALCUTTA 

Cancer  in  Cancer 
_^,,.      ^                 Malignant  Tumors          Percentage  ,Case 
Total  Number                                                                   of  All  Mortality- 
Year                                                  of  Cases                         Cases      Deaths                    Causes  per  100 

1911 25,905                    268        34                     1.03  12.7 

1912 28,246                     310         49                     1.10  15.8 

1911-1912 54,151                      578         83                     1.07  14.4 

HOSPITALS  IN  BENGAL,  EXCLUSIVE  OF  CALCUTTA 

1911 46,012                     381         21                     0.83  5.5 

1912 35,130                     215         16                     0.61  7.4 

1911-1912 81,142                    596         37                    0.73  6.2 

ALL  HOSPITALS  IN  BENGAL 

1911 71,917                     649         55                     0.90  8.5 

1912 63,376                     525         65                      0.83  12.4 

1911-1912 135,293                 1,174       120                     0.87  10.2 

Source:     Annual  Returns  of  the  Hospitals  and  Dispensaries  in  Bengal,  1911-1912. 

Table  235 
Mortality  from  Cancer  in  Ceylon,  1881-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

.Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

2,755,558 

69 

2.5 

1901 

3,582,697 

213 

5.9 

1882 

2,773,389 

84 

3.0 

1902 

3,636,736 

219 

6.0 

1883 

2,781,711 

97 

3.5 

1903 

3,690,775 

212 

5.7 

1884 

2,793,689 

99 

3.5 

1904 

3,744,814 

190 

5.1 

1885 

2,815,166 

83 

2.9 
3.1 

1905 
1901-1905 

3,798,853 

207 

5.4 

1881-1885 

13,919,513 

432 

18,453,875 

1,041 

5.6 

1886 

2,830,359 

85 

3.0 

1906 

3,852,892 

182 

4.7 

1887 

2,855,216 

92 

3.2 

1907 

3,906,931 

148 

3.8 

1888 

2,901,262 

117 

4.0 

1908 

3,960,970 

169 

4.3 

1889 

2,938,977 

141 

4.8 

1909 

4,015,009 

158 

3.9 

1890 

2,980,245 

171 

5.7 
4.2 

1910 
1906-1910 

4,069,048 

264 

6.5 

1886-1890 

14,506,059 

606 

19,804,850 

921 

4.7 

1891 

3,021,579 

139 

4.6 

1911 

4,124,362 

394 

9.6 

1892 

3,088,405 

187 

6.1 

1912 

4,179,676 

406 

9.7 

1893 

3,121,093 

235 

7.5 

1913 

4,234,990 

523 

12.3 

1894 

3,144,561 

196 

6.2 

1895 

3,193,821 

207 

6.5 

Source: 

Ceylon,     Administration     Re- 

ports.  Vita 

il  Statistics. 

1891-1895 

15,569,459 

964 

6.2 

1896 

3,240,501 

128 

4.0 

1897 

3,315,768 

177 

5.3 

1898 

3,395,519 

175 

5.2 

1899 

3,429,745 

191 

5.6 

1900 

3,520,574 

233 

6.6 

1896-1900 

16,902,107 

904 

5.3 

709 


APPENDIX  G 

Table  236 

Mortality  from  Cancer  in  Ceylon,  by  Organs  and  Parts 

1911-1913 

Deaths  Rate  per 

Organ  or  Part  from  100,000 

Cancer  Population 

Buccal  cavity 422  3.42 

Stomach  and  liver 334  2.71 

Peritoneum,  intestines  and  rectum 13  0.11 

Female  generative  organs 50  0.41 

Female  breast 52  0.42 

Skin 29  0.23 

Other  or  not  specified  organs 423  3.43 

All  organs 1,323  10.72 

Source:     Ceylon:  Administrative  Reports,  Vital  Statistics. 

Table  237 
Mortality  from  Cancer  in  Ceylon,  by  Organs  and  Parts,  according  to  Race 

1911-1913 


Europeans . 
Burghers. . 
Sinhalese.  . 

Tamils 

Moors .... 
Malays.  . . 
Others. . . . 


Total. 


from 
Cancer 

Europeans 

Burghers 5 

Sinhalese 32 

Tamils 11 

Moors 2 

Malays 

Others 


Population 

22,832 

79,604 

8,033,188 

3,328,546 

787,398 

38,259 

51,835 

12,341,662 

Female  Genebative 

Organs 
Deaths      Rate  per 
100,000 
Population 


Total. 


50 


0.40 
0.33 
0.25 


0.41 


Buccal  Cavity 

Deaths         Rate  per 
from  100,000 

Cancer        Population 


5 

6.28 

!32 

4.13 

52 

1.56 

30 

3.81 

1 

2.61 

2 

3.86 

422 


3.42 


Breast 


Deaths 

from 

Cancer 

1 

34 

11 

5 

1 


52 


Rate  per 

100,000 

Population 

4.38 

0.42 
0.33 
0.64 
2.61 


0.42 


Stomach  and  Liver 


Deaths 
from 
Cancer 

3 
5 

298 
16 
11 

1 

334 


Rate  per 

100,000 

Population 

13.14 
6.28 
3.71 
0.48 
1.40 

1.93 

2.71 


Skin 

Deaths        Rate  per 

from  100,000 

Cancer      Population 


20 
6 
3 


29 


0.25 
0.18 
0.38 


0.23 


Source:     Ceylon:  Administrative  Reports,  Vital  Statistics. 


710 


APPENDIX  G 

Table  238 
Mortality  from  Cancer  in  Ceylon,  by  Administrative  Divisions 

1911-1913 


District  Population 

Colombo 1,982,286 

Negombo 509,029 

Kalutara 850,752 

Kandy 1,232,085 

Matale 321,912 

Nuwara  Eliya 472,698 

Galle 886,442 

Matara 688,166 

Hambantota 323,133 

Jaffna 987,486 

Mannar 75,519 

Mullaittivu 50,861 

Batticaloa 468,686 

Trimcomalee 89,243 

Kurunegala 911,771 

Puttalam 117,924 

Chilaw 263,532 

Anuradhapura 256,459 

Badulla 651,463 

Ratnapura 492,131 

Kegalla 710,484 

All  Ceylon 12,342,662 

Source:     Ceylon:  Administrative  Reports,  Vital  Statistics. 


Deaths 

Rate  per 

from 

100,000 

CanctT 

Population 

343 

17.3 

52 

10.2 

111 

13.0 

134 

10.9 

44 

13.7 

44 

9.3 

104 

11.7 

78 

11.3 

40 

12.4 

68 

6.9 

18 

23.8 

5 

9.8 

8 

1.7 

13 

14.6 

31 

3.4 

13 

11.0 

26 

9.9 

4 

1.6 

89 

13.7 

58 

11.8 

40 

5.6 

1,323 


10.7 


Table  239 

Cases  of  Cancer  in  the  Hospitals  of  Straits  Settlements 

1904-1912 


Admissions 

Year                                             All  Causes          Cancer  Per  Cent. 

1904 23,717              47  0.20 

1905 23,990              61  0.25 


1906 24,966 

1907 26,393 

1908 27,913 

1909 27,763 

1910 32,875 


1906-1910 139,910 

1911 43,970 

1912 38,060 

Source:     Straits  Settlements,  Annual  Reports  on  the  Medical  Department. 


Deaths 

All  Causes         Cancer  Per  Cent. 
3,833              25  0.65 

3,685  30  0.81 


55 

0.22 

3,832 

27 

0.70 

84 

0.32 

3,686 

36 

0.98 

71 

0.25 

4,031 

38 

0.94 

76 

0.27 

3,635 

35 

0.96 

93 

0.28 
0.27 

4,500 

41 
177 

0.91 

79 

19,684 

0.90 

67 

0.15 

6,101 

26 

0.43 

85 

0.22 

4,581 

50 

1.09 

711 


APPENDIX  G 


Table  240 

Table  241 

Mortality  from  Cancer 

in  Singapore 

Mortality 

from  Cancer  in  the  Prov- 

1904-1913 

ince  of  Penang,  Straits  Settlements 

1909- 

1913 

Population 

Deaths 
from 

Rate  per 
100,000 

Year 

Cancer 

Population 

Deaths 

Rate  per 

1904 

253,584 

30 

11.8 

Year 

Population 

from 
Cancer 

100,000 
Population 

1905 

261,927 

56 

21.4 

1909 

272,043 

19 

7.0 

1906 

270,270 

48 

17.8 

1910 

275,023 

25 

9.1 

1907 

278,613 

21 

7.5 

1911 

278,003 

29 

10.4 

1908 

286,956 

26 

9.1 

1912 

282,176 

29 

10.3 

1909 

295,299 

57 

19.3 

1913 

284,565 

38 

13.4 

1910 

303,642 

29 

9.6 

1909-1913 

1,391,810 

140 

10.1 

1906-1910 

1,434,780 

181 

12.6 

Source: 

Straits    Settlements, 

Annual 

1911 
1912 

320,328 
328,671 

26 
39 

8.1 
11.9 

Reports  on 
Deaths 

the  Registration  of  Births  and 

1913 

337,014 

11 

3.3 

Note :    Includes  the  Provinces  of  Welles- 

Source: 

Straits    Settlements 

Annual 

ley  and  Dindings. 

Reports  on 

the  Registration  of  Births  and 

Deaths. 

Table  242 
Cases  of  Cancer  in  Tan  Tock  Seng's  Hospital,  Singapore,  by  Organs  and  Parts 

1907-1912 


Carcinoma  of 
Glands  of  neck .  .  . 

Lungs 

(Esophagus 

Stomach 

Liver 

Intestines 

Pancreas 

Kidney 

Suprarenal  glands 


All  carcinoma 
Sarcoma  of 
Mediastinum . 
Heart 


No.  of  Cases 


Kidney. 
Bones . . 


All  sarcoma  .  . . 
Epithelioma  of 
Jaw 


Tongue 

Pharynx 

Scalp 

Penis 

Arising  from  scars . 


All  epithelioma  . 
Glioma  of  brain . 


7 
3 
21 
31 
1 
1 
1 
2 

95 

5 
1 
1 
3 

10 


2 
1 

4 
4 

14 


All  organs 121 

Source:     Straits  Settlements,  Annual  Reports  on  the  Medical  Department. 


Per  Cent. 

23.1 
5.8 
2.5 
17.4 
25.6 
0.8 
0.8 
0.8 
1.7 

78.5 

4.1 
0.8 
0.8 
2.5 


0.8 
1.7 
1.7 
0.8 
3.3 
3.3 

11.6 
1.7 

100.0 


712 


APPENDIX  G 

Table  243 

Admissions  and  Mortality  from  Cancer,  Victoria  Hospital,  Seychelles 

1900-1902  and  1907-1911 


Admissions 

Deaths 

Per  Cent. 

Per  Cent 

Year 

All  Causes 

Cancer        of  AH 
Causes 

All  Causes 

Cancer 

of  All 
Causes 

1900 

219 

2            0.9 

10 

2 

20.0 

1901 

249 

2            0.8 

17 

1902 

26G 

6            2.3 

14 

1 

7.1 

1900-1902 

734 

10            1.4 
2            0.8 

41 
14 

3 

7  3 

1907 

266 

1908 

369 

2            0.5 

14 

1909 

369 

4            1.1 

26 

1 

3.8 

1910 

460 

13            2.8 

30 

2 

6.7 

1911 

579 

7            1.2 
28            1.4 

26 
110 

2 
5 

7.7 

1907-1911 

2,043 

4.5 

Source:     Selections  from  Colonial  Medical  Reports  for   1900-1902. 
Colony  of  Seychelles,  Blue  Book. 

Table  244 

Admissions  and  Mortality  from  Cancer,  by  Organs  and  Parts 

Victoria  Hospital,  Seychelles,  1907-1911 


Organ  or  Part 

Stomach 

Pylorus 

Rectum 

Bladder 

Uterus 

Ovary 

Other  or  not  specified 

Adenocarcinoma 

Epithelioma 

Sarcoma 


Admissions 

Number               Per  Cent 

4 

14.3 

1 

3.6 

1 

3.6 

1 

3.6 

9 

32.1 

2 

7.1 

2 

7.1 

1 

3.6 

5 

17.9 

2 

7.1 

All  organs 28 

Source:     Colony  of  Seychelles,  Blue  Book. 


100.0 


Deaths 

Number  Per  Cent. 

1  20.0 

1  20.0 


40.0 
20.6 


100.0 


Table  245 

Mortality  from  Cancer  among  Europeans 

in  Dutch  East  Indies 

1911-1912 


Year 

1911 
1912 

Population 

63,000 
63,000 

Deaths 
from 
Cancer 

54 

51 

Rate  per 

100,000 

Population 

85.7 

81.0 

1911-1912 

126,000 

105 

83.3 

Source:  Handelingen  der  Staaten-Gen- 
eraal.  Bijlagen  1912-1913,  1913-1914.  Ned- 
erlandsch-Indie . 


713 


APPENDIX  G 

Table  246 

Mortality  from  Cancer  in  Hongkong,  China,  by  Race 

1901-1912 


Civil  Eukopeans 

Chinese 

Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1901 

9,560 

6 

62.8 

280,564 

21 

7.5 

1902 

10,082 

7 

69.4 

285,677 

11 

3.9 

1903 

10,605 

2 

18.9 

290,790 

13 

4.5 

1904 

11.128 

3 

27.0 

295,903 

14 

4.7 

1905 

11,651 

8 
26 

7 

68.7 
49.0 
57.5 

301,016 

20 
79 
15 

6.6 

1901-1905 

53,026 

1,453,950 
306,130 

5.4 

1906 

12,174 

4.9 

1907 

12,162 

7 

57.6 

315,862 

19 

6.0 

1908 

12,149 

7 

57.6 

325,594 

10 

3.1 

1909 

12,136 

6 

49.4 

335,326 

24 

7.2 

1910 

12,123 

5 

32 

5 

41.2 
52.7 
41.3 

345,058 

21 
89 
36 

6.1 

1906-1910 

60,744 

1,627,970 
354,790 

5.5 

1911 

12,110 

10.1 

1912 

12,400 

6 

48.4 

356,020 

37 

10.4 

Source:     Reports  on  the  Health  and  Sanitary  Condition  of  the  Colony  of  Hongkong. 

Table  247 

Mortality  from  Cancer,  by  Organs  and  Parts,  among  the 

Chinese  Population  of  Hongkong 

1895-1904 

Deaths  Rate  per 

from  100,000 

Carcinoma  of                                                                                                              Cancer  Population 

Mouth  and  jaw 7  0.26 

CEsophagus 3  0.11 

Stomach 19  0.72 

Rectum 4  0.15 

Peritoneum 3  0.11 

Liver 14  0.53 

Skin 3  0.11 

Neck 1  0.04 

Breast 6  0.23 

Uterus 14  0.53 

Vagina 1  0.04 

Bladder 1  0.04 

Penis 3  0.11 

Other  or  not  specified 24  0.90 

Sarcoma 16  0.60 

All  organs 119  4.48 

Source:     Correspondence  relating  to  the  Cancer  Research  Scheme,  London,  1906. 


714 


APPENDIX  a 


Table  248 

Table  249 

Mortality  from  Cancer  in  Shanghai 

Mortality  from  Cancer  in 

Japan 

China, 

among  Resident  Foreign 

1899-1911 

Pomi1ci<-<r>n 

1898-1Q14 

D      th 

T> 

Resident 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Foreign 

from 

100,000 

Cancer 

Population 

Population 

Cancer 

Population 

1899 

44,003,530 

19,382 

44.0 

1898 

5,938 

1 

16.8 

1900 

44,577,790 

20,334 

45.6 

1899 

6,356 

4 

62.9 

1900 

6,774 

5 

73.8 

1901 

45,152,050 

22,149 

49.1 

1902 

45,726,310 

24,598 

53.8 

1901 

7,718 

4 

51.8 

1903 

46,300,570 

25,550 

55.2 

1902 

8,662 

2 

23.1 

1904 

46,846,690 

25,993 

55.5 

1903 

9,607 

3 

31.2 

1905 

47,392,810 

26,668 

56.3 

1904 

10,552 

3 

28.4 

1905 

11,497 

5 

43.5 
35.4 

1901-1905 
1906 

231,418,430 
47,938,930 

124,958 
27,863 

54.0 

1901-1905 

48,036 

17 

58.1 

1907 

48,492,085 

28,451 

58.7 

1906 

11,904 

6 

50.4 

1908 

49,045,240 

30,440 

62.1 

1907 

12,312 

6 

48.7 

1909 

49,591,360 

32,543 

65.6 

1908 

12,720 

8 

62.9 

1910 

50,137,480 

32,741 

65.3 

1909 

13,128 

8 

60.9 

1910 

13,536 

5 

36.9 
51.9 

1906-1910  245,205,095 
1911         50,683,600 

152,038 
33,888 

62.0 

1906-1910 

63,600 

33 

66.9 

1911 

13,770 

8 

58.1 

Source: 

Mouvement  de  la  Population 

1912 

14,000 

8 

57.1 

de  L'Emp 

re  du  Japon. 

1913 

14,250 

9 

63.2 

1914 

14,300 

.14 

97.9 

Source: 

Shanghai 

Municipal 

Council, 

Health  Department,  Annual  Reports. 

Table  248a 

Surgical  Cases  of  Malignant  Tumor  in  the  Yunghun  Hospital 

Fukien,  China,  by  Organs  and  Parts 

1911-1914* 


Organ  or  Part 

Carcinoma  of  breast 

Carcinoma  of  glands  in  neck,  recurrent  from  breast. 

Carcinoma  of  ovaries 

Sarcoma  of  abdominal  wall 

Sarcoma  of  neck  glands 

Sarcoma  of  testicle 

Sarcoma  of  finger 

Myeloid  sarcoma  of  tibia 

Epithelioma  of  cheek 


Cases 
4 


Per  Cent. 
30.8 

7.7 

7.7 

15.4 

7.7 
7.7 
7.7 
7.7 
7.7 


100.0 


All  organs 13 

General  surgical  and  gynecological  operations  performed,  exclu- 
sive of  operations  on  eyes  and  teeth 1,079 

Operations  for  malignant  tumors  in  per  cent,  of  total 1.2 

Source:    Annual  Reports  of  the  Yunghun  Hospital,  Fukien  (English  Presbyterian 
Mission). 

*Three  fiscal  years. 


715 


APPENDIX  G 


Table  250 

Mortality  from  Cancer  in  Japan,  by  Sex 

1899-1910 


MALES 

FEMALES 

Year 

1899 
1900 

Population 

22,199,781 
22,493,953 

Deaths 
from 
Cancer 

9,780 
10,250 

Rate  per 

100,000 

Population 

44.1 
45.6 

Year 

1899 
1900 

Population 

21,803,749 
22,083,837 

Deaths 
from 
Cancer 

9,602 

10,084 

Rate  per 

100,000 

Population 

44.0 

45.7 

1901 
1902 
1903 
1904 
1905 

22,788,240 
23,082,641 
23,381,788 
23,666,948 
23.923,890 

11,050 
12,304 
12,972 
13,177 
13,564 

48.5 
53.3 
55.5 
55.7 
56.7 

54.0 

1901 
1902 
1903 
1904 
1905 

1901-1905 

22,363,810 
22,643,669 
22,918,782 
23.179,742 
23,468,920 

11,099 
12,294 
12,578 
12,816 
13,104 

49.6 
54.3 
54.9 
55.3 

55.8 

1901-1905 

116,843,507 

63,067 

114,574,923 

61,891 

54.0 

1906 
1907 
1908 
1909 
1910 

24,180,396 
24,440,011 
24,708,992 
24,974,209 
25.249,235 

14,261 
14,411 
15,352 
16,602 
16,604 

59.0 
59.0 
62.1 
66.5 
65.8 

62.5 

1906 
1907 
1908 
1909 
1910 

1906-1910 

23,758,534 
24,052,074 
24,336,248 
24,617,151 

24,888,245 

13,602 
14,040 
15,088 
15,941 
16,137 

57.3 
58.4 
62.0 
64.8 
64.8 

1906-1910 

123,552,843 

77,230 

121,652,252 

74,808 

61.5 

Source:     Mouvement 
de  L'Empire  du  Japon. 

de   la  Population 

Table  251 
Mortality  from  Cancer  in  Japan,  by  Organs  and  Parts,  according  to  Sex 

1909-1910 


MALES 


Deaths 
from 

Carcinoma  of  Cancer 

Buccal  cavity 1,098 

Stomach  and  liver 24,331 

Peritoneum,  intestines  rectum.  .  .    1,777 

Female  generative  organs 

Breast 

Skin 444 

Other  organs 4,328 

Not  specified 329 

Other  malignant  tumors 899 


Rate  per 

100,000 

Population 

2.2 

48.4 

3.5 


0.9 

8.6 
0.7 
1.8 


FEMALES 

Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

429 

0.9 

15,530 

31.4 

1,684 

3.4 

10,322 

20.8 

878 

1.8 

290 

0.6 

1,888 

3.8 

307 

0.6 

750 

1.5 

All  organs 33,206  66.1  32,078 

Source :     Statistlque  des  causes  de  deces  de  L'Empire  du  Japon. 


64.8 


716 


APPENDIX  G 

Table  252 

Mortality  from  Cancer  in  Japan,  by  Age  and  Sex 

1908-1910 


MALES 

Deaths 

Ages                                                                                                    Population  from 

Cancer 

Under  25 38,732,576  378 

25-34 11,607,034  670 

35-44 8,729,629  3,202 

45-54 6,856,318  10,333 

55-64 5,417,615  18,737 

65-74 2,577,676  12,107 

75  and  over 1,011,588  .          3,131 

All  ages 74,932,436  48,558 

FEMALES 

Under  25 37,873,379  450 

25-34 11,423,302  2,154 

35-44 8,336,722  6,288 

45-54 6,564,522  10,797 

55-64 5,419,977  14,698 

65-74 2,894,592  9,436 

75  and  over 1,329,150  3,343 

All  ages 73,841,644  47,166 

Source:     Statistique  des  causes  de  deces  de  L'Empire  du  Japon. 


Rate  per 

100,000 

Population 

1.0 

5.8 
36.7 
150.7 
345.9 
469.7 
309.5 

64.8 


1.2 
18.9 
75.4 
164.5 
271.2 
326.0 
251.5 


63.9 


Table  253 

Mortality  from  Cancer  in  Tokyo 

1904-1910 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1904 
1905 

1,400,000 
1,459,000 

1,074 
1,071 

76.7 

73.4 

1906 
1907 
1908 
1909 
1910 

1,523,000 
1,580,000 
1,601,000 
1,623,079 
1,805,800 

1,107 
1,111 
1,191 
1,225 

1,284 

72.7 
70.3 
74.4 
75.5 
71.1 

1906-1910     8,132,879         5,918 


72.8 


Source:    Tenth  Annual  Statistics  of  the 
City  of  Tokyo,  1913. 


717 


APPENDIX  G 

Table  254 

Mortality  from  Cancer  in  Tokyo,  by  Sex 

1904-1910 


MALES 

FEMALES 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1904 
1905 

778,000 
811,000 

555 
549 

71.3 
67.7 

1904 
1905 

622,000 
648,000 

519 

522 

83.4 

80.6 

1906 
1907 
1908 
1909 
1910 

846,000 
878,000 
890,000 
902,433 
1,004,025 

576 
602 
604 
627 
646 

68.1 
68.6 
67.9 
69.5 
64.3 

67.6 

1906 
1907 
1908 
1909 
1910 

1906-1910 

677,000 
702,000 
711,000 
720,646 
801,775 

531 
509 

•       587 
598 
638 

78.4 
72.5 
82.6 
83.0 
79.6 

1906-1910 

4,520,458 

3,055 

3,612,421 

2,863 

79.3 

Source:     Tenth  Annual  Statistics  of  the 
City  of  Tokyo,  1913. 

Table  255 

Mortality  from  Cancer  in  Osaka,  by  Sex 

1906-1910 


TOTAL 

MALES 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1906 
1907 
1908 
1909 
1910 

1,134,332 
1,180,461 
1,226,590 
1,232,982 
1,250,000 

625 
587 
655 
698 
739 

55.1 
49.7 
53.4 
56.6 
59.1 

54.8 

1906 
1907 
1908 
1909 
1910 

1906-1910 

621,047 
646,302 
671,558 
675,058 
685,000 

309 
292 
312 
361 
379 

49.8 
45.2 
46.5 
53.5 
55.3 

1906-1910 

6,024,365 

3,304 

3,298,965 

1.653 

50.1 

Year 

1906 
1907 
1908 
1909 
1910 


FEMALES 

Deaths 


Population 

513,285 
534,159 
555,032 
557,924 
565,000 


from 
Cancer 

316 
295 
343 
337 
360 


Rate  per 

100,000 

Population 

61.6 
55.2 
61.8 
60.4 
63.7 


1906-1910     2,725,400         1,651 


60.6 


Source:     Mouvement  de  la  Population 
de  L'Empire  du  Japon,  1906-1910. 


718 


APPENDIX  G 


Table  256 

Table  257 

Mortality  from  Cancer  in 

Kyoto 

Mortality  from  Cancer  in 

Manila 

by  Sex 

Philippine 

Islands 

1906-191 

0 

Year 

1903-1^ 

H3 

Deaths 

TOTAL 

Rate  per 

Deaths 

Rate  per 

(Ending 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

June  30) 

Cancer, 

Population 

Cancer 

Population 

1903 

219,941 

29 

13.2 

1906 

417,704 

381 

91.2 

1904 

220,841 

28 

12.7 

1907 

430,083 

412 

95.8 

1905 

221,741 

35 

15.8 

1908 

442,462 

381 

86.1 

1909 

456,247 

436 

95.6 

1906 

222,641 

38 

17.1 

1910 

470,000 

376 

80.8 

1907 

223,542 

62 

23.3 

1908 

227,164 

63 

27.7 

1906-1910 

2,216,496 

1,986 

89.6 

■  1909 

230,786 

64 

27.7 

MALES 

1910 

234,409 

72 

30.7 

1906 

215,285 

218 

101.3 

1907 

221,665 

224 

101.1 

1906-1910 

1,138,542 

289 

25.4 

1908 

228,045 

203 

89.0 

1909 

235,150 

226 

96.1 

1911 

238,031 

68 

28.6 

1910 

242,050 

201 

83.0 

1912 

241,653 

63 

26.1 

1913 

245,275 

58 

23.6 

1906-1910 

1,142,195 

1,072 

93.9 

Source: 

Annual  Reports  of  the  Bureau  of 

FEMALEb 

Health  for  the  Philippin 

e  Islands 

1906 

202,419 

163 

80.5 

1907 

208,418 

188 

90.2 

1908 

214,417 

178 

83.0 

1909 

221,097 

210 

95.0 

1910 

227,950 

175 

76.8 
85.1 

1906-1910 

1,074,301 

914 

Source: 

Mouvement 

de  la  Population 

de  L'Empire  du  Japon,  1906-1910 

Table  258 

Mortality  from  Cancer  in  Manila,  by  Organs  and  Parts 

according  to  Race 

1908-1913 


White  Race 


Organ  or  Part 

Buccal  cavity 

Stomach  and  liver 

Peritoneum,  intestines,  rectum 

Female  generative  organs 

Breast 

Skin 

Other  or  not  specified 

AU  organs 


Deaths 

from 

Cancer 


Rate  per 

100,000 

Population 

5.1 


10.1 


20 


12.6 


50.6 


Filipinos 


Deaths 

from 
Cancer 

43 
59 


25 
9 

82 

293 


Rate  per 

100,000 

Population 

4.0 
5.4 
2.0 
4.9 
2.3 
0.8 
7.6 

27.0 


Chinese 

Deaths      Rate  per 

from         100,000 

Cancer    Population 

3  4.7 

5  7.8 


12 


6.3 


18.8 


Source:  Annual  Reports  of  the  Bureau  of  Health  for  the  Philippine  Islands. 


719 


APPENDIX  G 

Table  259 
Mortality  from  Cancer  in  the  Countries  of  Australasia 

Deaths  Rate  per 

Population  from  100,000 

Cancer  Population 

Hawaii 962,860  392  40.7 

New  South  Wales 8,142,200  5,948  73.1 

New  Zealand 4,963,912  3,731  75.2 

Northern  Territory 6,678  3  44.9 

Queensland 2,961,089  1,870  63.2 

South  Austraha 1,996,995  1,525  76.4 

Tasmania 950,717  621  65.3 

Victoria 6,521,936  5,441  83.4 

Western  Austraha 1,380,353  814  59.0 

Total , 27,886,740  20,345  73.0 

Population,  1911:  5,703,425. 

Note:  The  data  are  given  for  Hawaii,  1908-1912,  for  New  South  Wales,  1908-1912, 
for  New  Zealand,  1908-1912,  for  Northern  Territory,  1911-1912,  for  Queensland,  1908- 
1912,  for  South  Australia,  1908-1912,  for  Tasmania,  1908-1912,  for  Victoria,  1908-1912, 
for  Western  Australia,  1908-1912. 

Table  260 

Mortality  from  Cancer  in  the  Commonwealth  of  Australia 

1881-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

2,269,135 

784 

34.6 

1901 

3,790,710 

2,401 

63.3 

1882 

2,347,410 

800 

34.1 

1902 

3,847,998 

2,467 

64.1 

1883 

2,446,910 

896 

36.6 

1903 

3,893,329 

2,396 

61.5 

1884 

2,555,731 

956 

37.4 

1904 

3,942,730 

2,371 

60.1 

•  1885 

2,650,123 

942 

35.5 
35.7 

1905 
1901-1905 

4,001,117 

2,539 

63.5 

1881-1885 

12,269,309 

4,378 

19,475,884 

12,174 

62.5 

1886 

2,741,286 

1,097 

40.0 

1906 

4,060,324 

2,608 

64.2 

1887 

2,834,708 

1,156 

40.8 

1907 

4,123,729 

2,940 

71.3 

1888 

2,931,521 

1,215 

41.4 

1908 

4,194,410 

2,921 

69.6 

1889 

3,022,077 

1,375 

45.5 

1909 

4,274,617 

3,112 

72.8 

1890 

3,106,917 

1,358 

43.7 
42.4 

1910 
1906-1910 

4,370,185 

3,205 

73.3 

1886-1890 

14,636,509 

6,201 

21,023,265 

14,786 

70.3 

1891 

3,196,172 

1,593 

49.8 

1911 

4,490,366 

3,321 

74.0 

1892 

3,273,371 

1,557 

47.6 

1912 

4,644,852 

3,537 

76.1 

1893 

3,333,825 

1,613 

48.4 

1913 

4,803,661 

3,603 

75.0 

1894 

3,394,328 

1,681 

49.5 

1895 

3,459,192 

1,771 

51.2 

Source: 

Annual  Reports  of  the  Regis- 

trar-General  of  Rirths 

DpatVis   anr\    Mnr- 

1891-1895 

16,656,888 

8,215 

49.3 

riages    in 

England    and    Wales 

Official 

Statistics, 

Commonwealth    of 

1896 

3,522,362 

1,904 

54.1 

Australia. 

Annual  Bulletins  of  Common- 

1897 

3,585,442 

1,971 

55.0 

wealth  Demography. 

1898 

3,641,251 

2,145 

58.9 

1899 

3,690,353 

2,200 

59.6 

1900 

3,740,665 

2,341 

62.6 
58.1 

1896-1900 

18,180,073 

10,561 

720 


APPENDIX  G 

Table  261 

Mortality  from  Cancer  in  the  Commonwealth  of  Australia 

by  Organs  and  Parts,  according  to  Sex 

1908-1912 


MALES 


Organ  or  Part 


Deaths 

from 
Cancer 

Lips 153 

Tongue 452 

Mouth 117 

Jaw 380 

Pharynx 248 

Esophagus 242 

Stomach 2,254 

Liver  and  gall-bladder 1,045 

Peritoneum  and  mesentery 36 

Intestines 605 

Rectum 292 

Pancreas 172 

Ovary  and  fallopian  tube 

Uterus 

Breast 11 

Skin 335 

Larynx 121 

Lungs  and  pleura 99 

Kidneys  and  suprarenal  glands ...  98 

Bladder 172 

Prostate 170 

Brain 17 

Other  organs 889 

Not  specified 517 


All  organs 8,425 


Rate  per 

100,000 

Population 

1.3 
4.0 
1.0 
3.3 
2.2 
2.1 
19.7 
9.2 
0.3 
5.3 
2.5 
1.5 


0.1 
2.9 
1.1 
0.9 
0.9 
1.5 
1.5 
0.1 
7.9 
4.5 


73.8 


FEMALES 

Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

11 

0.1 

21 

0.2 

10 

0.1 

61 

0.6 

25 

0.2 

51 

0.5 

1,246 

11.8 

1,024 

9.7 

45 

0.4 

640 

6.1 

268 

2.5 

101 

0.9 

118 

1.0 

1,456 

13.8 

1,117 

10.6 

157 

1.5 

15 

0.1 

58 

0.5 

54 

0.5 

60 

0.6 

20 

0.2 

600 

5.7 

513 

4.8 

rt  R'71 

na  et 

7,671 


Males,  45  years  and  over,  20.11  per  cent,  of  population.     Females,  45  years  and  over, 
17.95  per  cent,  of  population. 

Source:     Ofl5cial  Statistics,  Commonwealth  of  Australia.     Annual  Bulletins  of  Com- 
monwealth Demography. 


721 


APPENDIX  G 

Table  262 
Mortality  from  Cancer  in  the  Commonwealth  of  Australia,  by  Age  and  Sex 

1908-1912 


MALES 


Population 


Under  25 5,791,262 

25-34 1,840,288 

35-44 1,471,775 

45-54 1,195,675 

55-64 612,669 

65-74 343,414 

75  and  over 154,023 

Not  stated 

All  ages 11,409,106 

FEMALES 

Under  25 5,622,866 

25-34 1,726,374 

35-44 1,310,100 

45-54 958,275 

55-64 500,796 

65-74 309,564 

75  and  over 137,349 

Not  stated 

All  ages 10,565,324 

Source:     Official  Statistics,  Commonwealth  of  Australia, 
mon wealth  Demography. 


Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

191 

3.3 

157 

8.5 

571 

38.8 

1,643 

137.4 

2,095 

341.9 

2,401 

699.2 

1,356 

880.4 

11 

8,425 


73.8 


149 

2.6 

249 

14.4 

948 

72.4 

1,688 

176.1 

1,746 

348.6 

1,763 

569.5 

1,126 

819.8 

2 

7,671  72.6 

Annual  Bulletins  of  Com- 


APPENDIX  G 

Table  263 

Mortality  from  Cancer  in  New  South  Wales 

1881-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

765,015 

216 

28.2 

1906 

1,484,600 

1,027 

69.2 

1882 

798,540 

215 

26.9 

1907 

1,517,900 

1,085 

71.5 

1883 

838,155 

215 

25.7 

1908 

1,545,700 

1,058 

68.4 

1884 

883,145 

233 

26.4 

1909 

1,577,200 

1,166 

73.9 

1885 

927,275 

267 

28.8 
27.2 

1910 
1906-1910 

1,616,200 

1,179 

72.9 

1881-1885 

4,212,130 

1,146 

7,741,600 

5,515 

71.2 

1886 

969,455 

333 

34.3 

1911 

1,664,500 

1,233 

74.1 

1887 

1,004,835 

354 

35.2 

1912 

1,738,600 

1,312 

75.5 

1888 

1,035,705 

404 

39.0 

1913 

1,809,400 

1,332 

73.6 

1889 

1,066,450 

393 

36.9 

1890 

1,101,840 

392 

35.6 

Source: 

Vital   Statistics   of  Pn 

'ew  South 

Wales,    1881-1 01  f? 

1886-1890 

5,178,285 

1,876 

36.2 

1891 

1,142,025 

516 

45.2 

1892 

1,176,990 

510 

43.3 

1893 

1,203,170 

489 

40.6 

1894 

1,226,900 

516 

42.1 

1895 

1,250,760 

556 

44.5 
43.1 

1891-1895 

5,999,845 

2,587 

1896 

1,270,620 

627 

49.3 

1897 

1,290,375 

693 

53.7 

1898 

1,312,455 

714 

54.4 

1899 

1,333,605 

761 

57.1 

1900 

1,354,335 

765 

56.5 
54.3 

1896-1900 

6,561,390 

3,560 

1901 

1,366,900 

847 

62.0 

1902 

1,388,400 

869 

62.6 

1903 

1,407,400 

930 

66.1 

1904 

1,428,700 

954 

66.8 

1905 

1,454,800 

965 

.  66.3 
64.8 

1901-1905 

7,046,200 

4,565 

723 


APPENDIX  G 


Table  264 

Table  265 

Mortality  from  Cancer  in  New  South 

Mortality  from  Cancer  in  New  South 

Wales,  Males, 

1881-19 

13 

Rate  per 

Wal 

es,  Females 

1881-] 

Deaths 

1913 

Deaths 

Rate  per 

Year 

Population 

from 

lOO.Ouo 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

419,025 

120 

28.6 

1881 

345,990 

96 

27.7 

1882 

438,060 

118 

26.9 

1882 

360,480 

97 

26.9 

1883 

460,540 

124 

26.9 

1883 

377,615 

91 

24.1 

1884 

486,145 

123 

25.3 

1884 

397,000 

110 

27.7 

1885 

510,670 

148 

29.0 

27.4 

1885 
1881-1885 

416,605 

119 

28.6 

1881-1885 

2,314,440 

633 

1,897,690 

513 

27.0 

1886 

533,145 

171 

32.1 

1886 

436,310 

162 

37.1 

1887 

550,805 

209 

37.9 

1887 

454,030 

145 

31.9 

1888 

565,770 

208 

36.8 

1888 

469,935 

196 

41.7 

1889 

581,100 

217 

37.3 

1889 

485,350 

176 

36.3 

1890 

599,330 

229 

38.2 
36.5 

1890 
1886-1890 

502,510 

163 

32.4 

1886-1890 

2,830,150 

1,034 

2,348,135 

842 

35.9 

1891 

618,847 

297 

48.0 

1891 

523,178 

219 

41.9 

1892 

634,790 

269 

42.4 

1892 

542,200 

241 

44.4 

1893 

646,650 

250 

38.7 

1893 

556,520 

239 

42.9 

1894 

657,420 

308 

46.8 

1894 

569,480 

208 

36.5 

1895 

667,800 

311 

46.6 
44.5 

1895 
1891-1895 

582,960 

245 

42.0 

1891-1895 

3,225,507 

1,435 

2,774,338 

1,152 

41,5 

1896 

676,350 

333 

49.2 

1896 

594,270 

294 

49.5 

1897 

686,137 

369 

53.8 

1897 

604,238 

324 

53.6 

1898 

696,952 

398 

57.1 

1898 

615,503 

316 

51.3 

1899 

706,167 

410 

58.1 

1899 

627,438 

351 

55.9 

1900 

714,757 

409 

57.2 
55.1 

1900 
1896-1900 

639,578 

356 

55.7 

1896-1900 

3,480,363 

1,919 

3,081,027 

1,641 

53.3 

1901 

716,300 

484 

67.6 

1901 

650,600 

363 

55.8 

1902 

725,700 

500 

68.9 

1902 

662,700 

369 

55.7 

1903 

733,800 

492 

67.0 

1903 

673,600 

438 

65.0 

1904 

744,300 

457 

61.4 

1904 

684,400 

497 

72.6 

1905 

757,900 

525 

69.3 
66.8 

1905 
1901-1905 

696,900 

440 

63.1 

1901-1905 

3,678,000 

2.458 

3,368,200 

2.107 

62.6 

1906 

772,800 

520 

67.3 

1906 

711,800 

507 

71.2 

1907 

789,400 

632 

80.1 

1907 

728,500 

453 

62.2 

1908 

801,900 

537 

67.0 

1908 

743,800 

521 

70.0 

1909 

818,200 

608 

74.3 

1909 

759,000 

558 

73.5 

1910 

840,100 

623 

74.2 
72.6 

1910 
1906-1910 

776,100 

556 

71.6 

1906-1910 

4,022,400 

2,920 

3,719,200 

2,595 

69.8 

1911 

868,300 

666 

76.7 

1911 

796,200 

567 

71.2 

1912 

913,100 

726 

79.5 

1912 

825,500 

586 

71.0 

1913 

951,200 

739 

77.7 

1913 

858,200 

593 

69.1 

Source: 

Vital   Statistics  for 

1913  and 

Source: 

Vital  Statistics  for 

1913   and 

previous  years,  New  South  Wales. 

previous  years.  New  South -Wales. 

724 


901-1910 

1911 

11.2 

13.0 

53.9 

54.6 

154.1 

167.5 

356.5 

345.9 

677.1 

672.7 

834.9 

945.2 

APPENDIX  G 

Table  266 

Mortality  from  Cancer  in  New  South  Wales,  by  Age  and  Sex 

1881-1911 

TOTAL 
Rate  per  100,000  Popdlation 

Ages                                                                           1881-1890  1891-1900 

25-34 10.1  10.7 

35-44 38.2  49.6 

45-54 113.7  145.2 

55-64 210.9  315.2 

65-74 336.3  471.8 

75  and  over 392.4  634.3 

All  ages 32.2  48.8                  67.7                  74.2 

MALES 

25-34 7.5  9.4 

35-44 28.8  36.3 

45-54 93.6  121.3 

55-64 119.5  303.6 

65-74 347.8  513.2 

75  and  over 412.4  637.8 

All  ages 32.4  49.9                  69.0                  76.8 

FEMALES 

25-34 13.6  12.4 

35-44 52.5  67.9 

45-54 146.3  179.3 

55-64 228.8  332.0 

65-74 318.5  430.0 

75  and  over 359.7  629.5 

All  ages 31.9  47.7                  66.2                  71.3 

Source:    The  Official  Year  Book  of  New  South  Wales,  1913. 


8.9 

11.9 

39.3 

45.5 

125.3 

141.9 

349.6 

355.6 

720.0 

741.4 

863.6 

888.9 

13.7 

14.2 

71.6 

65.0 

192.1 

20U.3 

365.4 

333.5 

620.6 

589.8 

799.8 

1,015.1 

725 


APPENDIX  G 


Table  267 

Mortality  from  Cancer  in  Sydney 

New  South  Wales 


1891-1913 


Year 

1891 
1892 
1893 
1894 
1895 


Population 

389,655 
406,540 
418,865 
429,410 
440,020 


1896 
1897 
1898 
1899 
1900 


448,850 
457,630 
467,445 
476,850 
486,070 


1896-1900  2,336,845 


1901 
1902 
1903 
1904 
1905 


493,810 
506,765 
518,960 
524,695 
530,655 


1906 
1907 
1908 
1909 
1910 


545,065 
567,005 
584,640 
599,000 
613,500 


1911 
1912 
1913 


639,515 
675,800 
710,100 


Deaths 
from 
Cancer 

210 


189 
199 
185 


1891-1895     2,084,490         1,027 


1901-1905     2,574,885         1,944 


481 
493 
493 
571 
548 


1906-1910     2,909,210         2,586 


572 
621 
677 


Rate  per 

100,000 

Population 

53.9 
60.0 
45.1 
46.3 
42.0 

49.3 


269 

59.9 

303 

66.2 

326 

69.7 

353 

74.0 

326 

67.1 

1,577 

67.5 

358 

72.5 

392 

77.4 

377 

72.6 

382 

72.8 

435 

82.0 

75.5 


86.9 
84.3 
95.3 
89.3 

88.9 

89.4 
91.9 
95.3 


Source:  New  South  Wales,  Vital  Sta- 
tistics, Annual  Reports,  1891-1913. 

Government  Statistician's  Reports  on 
the  Vital  Statistics  of  Sydney  and  Suburbs, 
1911-1912. 


Table  268 

Mortality  from  Cancer  in  Sydney 

Males,  1891-1913 


Year  Population 

1891  196,932 

1892  205,059 

1893  210,857 

1894  215,736 

1895  220,626 

1891-1895  1,049,210 


1896 
1897 
1898 
1899 
1900 


224,605 
228,540 
232,975 
237,185 

241,285 


1896-1900  1,164,590 


1901 
1902 
1903 
1904 
1905 


244,633 
250,798 
256,574 
259,147 
261,825 


1901-1905  1,272,977 


1906 
1907 
1908 
1909 
1910 


268,663 
279,193 
287,584 
294,349 
301,167 


Deaths 
from 
Cancer 

113 

110 

86 

100 


497 

125 
157 
149 
177 
148 

756 

172 
193 
170 
155 


902 

215 
280 
231 
280 
271 


1906-1910  1,430,956  1,277 

1911  310,593  265 

1912  328,216  301 

1913  344,874  328 


Rate  per 

100,000 

Population 

57.4 
53.6 
40.8 
46.4 
39.9 

47.4 

55.7 
68.7 
64.0 
74.6 
61.3 

64.9 

70.3 
77.0 
66.3 
59.8 
81.0 

70.9 

80.0 
100.3 
80.3 
95.1 
90.0 

89.2 

85.3 
91.7 
95.1 


Source:  New  South  Wales,  Vital  Sta- 
tistics, Annual  Reports,  1891-1913. 

Government  Statistician's  Reports  on 
the  Vital  Statistics  of  Sydney  and  Suburbs, 
1911-1912. 


726 


APPENDIX  G 


Table  269 

Mortality  from  Cancer  in  Sydney 

Females,  1891-1913 


Year 

1891 
1892 
1893 
1894 
1895 


Population 

192,723 
201,481 
208,008 
213,674 
219,394 


1891-1895  1,035,^ 


1896 
1897 
1898 
1899 
1900 


224,245 
229,090 
234,470 
239,665 
244,785 


1896-1900  1,172,255 


1901 
1902 
1903 
1904 
1905 


249,177 
255,967 
262,386 
265,548 
268,830 


Deaths 
from 
Cancer 

97 

134 

103 

99 

97 

530 

144 
146 
177 
176 

178 

821 

186 
199 
207 
227 
223 


Rate  per 

100,000 

Population 

50.3 
66.5 
49.5 
46.3 

44.2 


1901-1905  1,301,908    1,042 


1906 
1907 
1908 
1909 
1910 


276,402 
287,812 
297,056 
304,651 
312,333 


213 

262 
291 

277 


1906-1910  1,478,254    1,309 


1911 
1912 
1913 


328,922 
347,584 
365,226 


307 
320 
349 


64.2 
63.7 
75.5 
73.4 

72.7 

70.0 

74.6 

77.7 
78.9 
85.5 
83.0 

80.0 

96.2 
74.0 

88.2 
95.5 

88.7 

88.6 

93.3 
92.1 
95.6 


Source:  New  South  Wales,  Vital  Sta- 
tistics, Annual  Reports,  1891-1913. 

Government  Statistician's  Reports  on 
the  Vital  Statistics  of  Sydney  and  Suburbs, 
1911-1912. 


Table  270 

Mortality  from  Cancer  in  Victoria 

1881-1913 


Year 

1881 

1882 
1883 
1884 
1885 


Population 

866,285 
883,365- 
902,609 
924,115 
947,808 


1886 
1887 
1888 
1889 
1890 


976,778 
1,009,597 
1,052,277 
1,092,008 
1,119,333 


1891 
1892 
1893 
1894 
1895 


1,146,050 
1,163,560 
1,172,459 
1,179,163 
1,183,916 


1896 
1897 
1898 
1899 
1900 


1,182,763 
1,180,978 
1,182,194 
1,185,411 
1,192,377 


1901 
1902 
1903 
1904 
1905 


1,204,909 
1,214,226 
1,215,521 
1,216,905 
1,223,796 


1906 
1907 
1908 
1909 
1910 


1,236,729 
1,252,471, 
1,265,782 
1,281,058 
1,299,565 


1911 
1912 
1913 


1,321,212 
1,354,319 
1,393,180 


Deaths 
from 
Cancer 

351 
373 
450 
446 
445 


51.2   i  1881-1885  4,524,182    2,065 


496 

527 
521 
629 
626 


1886-1890  5,249,993    2,799 


699 
684 
734 
744 
760 


1891-1895  5,845,148    3,621 


789 
774 
864 
842 
817 


1896-1900  5,923,723    4,086 


852 
920 
893 
953 


1901-1905  6,075,357    4,500 


926 

992 

1,005 

1,030 

1,081 


1906-1910  6,335,605    5,034 


1,100 
1,225 
1,164 


Rate  per 

100,000 

Population 

40.5 
42.2 
49.9 
48.3 
47.0 

45.6 

50.8 
52.2 
49.5 
57.6 
55.9 

53.3 

61.0 
58.8 
62.6 
63.1 
64.2 

61.9 

66.7 
65.5 
73.1 
71.0 
68.5 

69.0 

73.2 
70.2 

75.7 
73.4 
77.9 

74.1 

74.9 
79.2 
79.4 
80.4 
83.2 

79.5 

83.3 
90.3 
83.5 

Vic- 


Source:        Statistical    Register    of 
toria  for  1912. 

OflBcial  Statistics,  Commonwealth  of  Aus 
tralia.  Commonwealth  Demography,  1913. 


727 


APPENDIX  G 


Table  271 

Table  272 

Mortality  from  Cancer  in 

Victoria 

Mortality 

from  Cancer  in 

Victoria 

Males,  1881 

-1913 

Deaths 

Rate  per 

F 

emales,  1881-1913 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Populatioi 

1881 

454,170 

172 

37.9 

1881 

412,115 

179 

43.4 

1882 

462,285 

208 

45.0 

1882 

421,080 

165 

39.2 

1883 

472,230 

234 

49.6 

1883 

430,379 

216 

50.2 

1884 

483,968 

221 

45.7 

1884 

440,147 

225 

51.1 

1885 

497,182 

234 

47.1 
45.1 

1885 
1881-1885 

450,626 

211 

46.8 

1881-1885 

2,369,835 

1,069 

2,154,347 

996 

46.2 

1886 

513,981 

247 

48.1 

1886 

462,797 

249 

53.8 

1887 

532,540 

275 

51.6 

1887 

477,057 

252 

52.8 

1888 

556,321 

276 

49.6 

1888 

495,956 

245 

49.4 

1889 

577,049 

324 

56.1 

1889 

514,959 

305 

59.2 

1890 

589,096 

338 

57.4 

52.7 

1890 
1886-1890 

530,237 

288 

54.3 

1886-1890 

2,768,987 

1,460 

2,481,006 

1,339 

54.0 

1891 

600,957 

407 

67.7 

1891 

545,093 

292 

53.6 

1892 

607,531 

359 

59.1 

1892 

556,029 

325 

58.5 

1893 

609,083 

406 

66.7 

1893 

563,376 

328 

58.2 

1894 

609,440 

375 

61.5 

1894 

569,723 

369 

64.8 

1895 

608,656 

418 

68.7 

1895 

575,260 

342 

59.5 

1891-1895 

3,035,667 

1,965 

64.7 

1891-1895 

2,809,481 

1,656 

58.9 

1896 

603,715 

422 

69.9 

1896 

579,048 

367 

63.4 

1897 

599,559 

396 

66.0 

1897 

581,419 

378 

65.0 

1898 

598,977 

445 

74.3 

1898 

583,217 

419 

71.8 

1899 

599,048 

444 

74.1 

1899 

586,363 

398 

67.9 

1900 

600,769 

435 

72.4 
71.4 

1900 
1896-1900 

591,608 

382 

64.6 

1896-1900 

3,002,068 

2,142 

2,921,655 

1,944 

66.5 

1901 

606,129 

483 

79.7 

1901 

598,780 

399 

66.6 

1902 

608,437 

444 

73.0 

1902 

605,789 

408 

67.4 

1903 

607,250 

487 

80.2 

1903 

608,271 

433 

71.2 

1904 

606,432 

453 

74.7 

1904 

610,473 

440 

72.1 

1905 

609,903 

498 

81.7 

77.8 

1905 
1901-1905 

613,893 

455 

74.1 

1901-1905 

3,038,151 

2,365 

3,037,206 

2,135 

70.3 

1906 

616,262 

466 

75.6 

1906 

620,467 

460 

74.1 

1907 

623,643 

499 

80.0 

1907 

628,828 

493 

78.4 

1908 

630,461 

497 

78.8 

1908 

635,321 

508 

80.0 

1909 

638,671 

530 

83.0 

1909 

642,387 

500 

77.8 

1910 

648,028 

564 

87.0 
81.0 

1910 
1906-1910 

651,537 

517 

79.4 

1906-1910 

3,157,065 

2,556 

3,178,540 

2,478 

78.0 

1911 

660,038 

535 

81.1 

1911 

661,174 

565 

85.5 

1912 

675,534 

572 

84.7 

1912 

678,785 

653 

96.2 

1913 

695,638 

574 

82.5 

1913 

697,542 

590 

84.6 

Source:  Statistical  Register  of  Vic- 
toria for  1912. 

Official  Statistics,  Commonwealth  of  Aus- 
tralia, Commonwealth  Demography,  1913. 


Source:  Statistical  Register  of  Vic- 
toria for  1912. 

Official  Statistics,  Commonwealth  of  Aus- 
tralia, Commonwealth  Demography,  1913. 


728 


APPENDIX  G 

Table  273 

Mortality  from  Cancer  in  Victoria,  by  Age  and  Sex 

1880-1882,  1890-1892,  1900-1902,  1909-1911 

Rate  per  100,000  of  Population 


MALES 

Ages  1880-1882  1890-1892 

Under  5 2.9  1.8 

5-9 2.4  1.0 

lO-U 1.8  1.1 

15-19 0.7  1.7 

20-24 2.5  3.2 

25-34 8.0  8.1 

35-44 41.2  42.9 

45-54 101.6  148.3 

55-64 220.1  319.2 

65-74 345.5  527.5 

75  and  over 451.2  585.5 

All  ages 42.9  61.6 

FEMALES 

Under  5 1.2  0.9 

5-9 1.2  1.0 

10-14 0.6  0.6 

15-19 2.6  1.2 

20-24 3.9  2.2 

25-34 26.5  16.8 

35-44 73.2  74.3 

45-54 150.7  180.0 

55-64 293.5  317.9 

65-74 326.8  539.6 

75  and  over 275.6  495.5 

All  ages 42.7  55.7 

Source:    Victorian  Year-book,  1911-1912. 


900-1902 

1909-1911 

3.0 

6.4 

4.2 

2.0 

2.0 

1.6 

2.2 

2.4 

3.3 

4.3 

12.6 

8.6 

36.9 

35.8 

141.4 

158.5 

360.0 

355.6 

590.4 

733.6 

740.4 

852.5 

75.2- 


66.4 


83.6 


2.6 

1.4 

0.4 

0.5 

2.1 

2.8 

4.4 

2.3 

3.5 

16.1 

13.7 

60.5 

72.9 

181.3 

162.3 

330.5 

330.1 

500.8 

574.1 

627.0 

774.9 

80.7 


729 


APPENDIX  G 


Table  274 

Table  275 

Mortality  from  Cancer  in 

South 

Mortality  from  Cancer  in 

South 

Australia, 

1881-1913 

Rate  per 

Aust 

ralia,  Males 

,  1882- 

Deaths 

1913 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

277,695 

91 

32.8 

1882 

150,325 

52 

34.6 

1882 

285,400 

89 

31.2 

1883 

153,767 

47 

30.6 

1883 

293,223 

86 

29.3 

1884 

157,812 

58 

36.8 

1884 

301,505 

109 

36.2 

1885 

159,106 

52 

32.7 

1885 

305,063 

100 

32.8 

1882-1885 

621,010 

209 

33.7 

1881-1885 

1,462,886 

475 

32.5 

1886 

157,758 

46 

29.2 

1886 

303,800 

104 

34.2 

1887 

157,606 

59 

37.4 

1887 

304,017 

110 

36.2 

1888 

157,303 

49 

31.2 

1888 

305,244 

116 

38.0 

1889 

158,025 

67 

42.4 

1889 
1890 

307,374 
311,976 

133 
129 

43.3 
41.3 

1890 

160,695 

68 

42.3 

1886-1890 

791,387 

289 

36.5 

1886-1890 

1,532,411 

592 

38.6 

1891 

162,950 

86 

52.8 

1891 

316,897 

156 

49.2 

1892 

167,385 

87 

52.0 

1892 

325,128 

148 

45.5 

1893 

172,925 

88 

50.9 

1893 

335,233 

171 

51.0 

1894 

175,642 

83 

47.3 

1894 
•    1895 

341,932 
345,466 

162 
166 

47.4 
48.1 

1895 

175,901 

86 

48.9 

1891-1895 

854,803 

430 

50.3 

1891-1895 

1,664,656 

803 

48.2 

1896 

173,578 

98 

56.5 

1896 

344,810 

186 

53.9 

1897 

172,545 

107 

62.0 

1897 

344,313 

185 

53.7 

1898 

173,897 

95 

54.6 

1898 

346,854 

184 

53.0 

1899 

177,145 

104 

58.7 

1899 
1900 

351,658 
354,268 

203 
210 

57.7 
59.3 

1900 

178,729 

103 

57.6 

1896-1900 

875,894 

507 

57.9 

1896-1900 

1,741,903 

968 

55.Q 

1901 

180,003 

105 

58.3 

1901 

357,556 

216 

60.4 

1902 

177,529 

126 

71.0 

1902 

355,934 

267 

75.0 

1903 

176,254 

133 

75.5 

1903 

355,437 

261 

73.4 

1904 

176,586 

112 

63.4 

1904 
1905 

356,968 
359,940 

226 
249 

63.3 
69.2 

1905 

179,182 

118 

65.9 

1901-1905 

889,554 

594 

66.8 

1901-1905 

1,785,835 

1,219 

68.3 

1906 

182,334 

139 

76.2 

1906 

363,110 

279 

76.8 

1907 

184,864 

134 

72.5 

1907 

367,710 

270 

73.4 

1908 

190,524 

139 

73.0 

1908 

377,994 

270 

71.4 

1909 

196,553 

154 

78.4 

1909 

388,439 

310 

79.8 

1910 

201,344 

158 

78.5 

1910 

397,700 

317 

79.7 

1906-1910 

955,619 

724 

75.8 

1906-1910 

1,894,953 

1,446 

76.3 

1911 

208,923 

148 

70.8 

1911 

411,218 

303 

73.7 

1912 

214,416 

173 

80.7 

1912 

421,644 

325 

77.1 

1913 

219,605 

181 

82.4 

1913 

433,588 

362 

83.5 

Source: 

Vital  Statistics  of  South  Aus- 

Source: 

Vital  Statistics  of  South  Aus- 

tralia. 

tralia. 

J 

730 


APPENDIX  G 


Table  276 

Table  277 

Mortality  from  Cancer  in 

South 

Mortality  from  Cancer  in  Qu 

eensland 

Australia,  Females,  1882 

-1913 

Rate  per 

1881-] 

1913 

Deaths 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1882 

135,075 

37 

27.4 

1881 

216,445 

65 

30.0 

1883 

139,456 

39 

28.0 

1882 

232,089 

54 

23.3 

1884 

143,693 

51 

35.5 

1883 

261,472 

70 

26.8 

1885 

145,957 

48 

32.9 

1884 

291,101 

94 

32.3 

1885 

309,134 

53 

17.1 

1882-1885 

564,181 

175 

31.0 

1881-1885 

1,310,241 

336 

25.6 

1886 

146,042 

58 

39.7 

1887 

146,411 

51 

34.8 

1886 

324,496 

92 

28.4 

1888 

147,941 

67 

45.3 

1887 

342,096 

81 

23.7 

1889 

149,349 

66 

44.2 

1888 

359,523 

88 

24.5 

1890 

151,281 

61 

40.3 

1889 

374,327 

130 

34.7 

1890 

386,803 

117 

30.2 

1 88fi-l  8Q0 

741,024 

303 

40.9 

±OOw     XOi/v* 

1886-1890 

1,787,245 

508 

28.4 

1891 

153,947 

70 

45.5 

1892 

157,743 

61 

38.7 

1891 

396,256 

134 

33.8 

1893 

162,308 

83 

51.1 

1892 

405,036 

130 

32.1 

1894 

166,290 

79 

47.5 

1893 

414,335 

121 

29.2 

1895 

169,565 

80 

47.2 

•      1894 

424,492 
436,528 

157 
189 

37.0 
43.3 

1895 

18Q1-18Q5 

809,853 

373 

46.1 

x(Ji7  X      X(Ji7*J 

1891-1895 

2,076,647 

731 

35.2 

1896 

171,232 

88 

51.4 

1897 

171,768 

78 

45.4 

1896 

447,885 

183 

40.9 

1898 

172,957 

89 

51.5 

1897 

458,000 

187 

40.8 

1899 

174,513 

99 

56.7 

1898 

469,078 

229 

48.8 

1900 

175,539 

107 

61.0 

1899 
1900 

480,588 
490,081 

243 
229 

50.6 

46.7 

18Qfi-1QnO 

866,009 

461 

53.2 

XiJij\J     l.iy\J\J 

1896-1900 

2,345,632 

1,071 

45.7 

1901 

177,553 

111 

62.5 

1902 

178,405 

141 

79.0 

1901 

501,432 

278 

55.4 

1903 

179,183 

128 

71.4 

1902 

510,450 

285 

55.8 

1904 

180,382 

114 

63.2 

1903 

514,483 

252 

49.0 

1905 

180,758 

131 

72.5 

1904 
1905 

521,815 

528,928 

297 
351 

56.9 
66.4 

1901-1905 

896,281 

625 

69.7 

1901-1905 

2,577,108 

1,463 

56.8 

1906 

180,776 

140 

77.4 

1907 

182,846 

136 

74.4 

1906 

536,200 

292 

54.5 

1908 

187,470 

131 

69.9 

1907 

542,730 

353 

65.0 

1909 

191,886 

156 

81.3 

1908 

553,619 

337 

60.9 

1910 

196,356 

159 

81.0 

1909 
1910 

569,950 
591,591 

341 
395 

59.8 
66.8 

1906-1910 

939,334 

722 

76.9 

1906-1910 

2,794,090 

1,718 

61.5 

1911 

202,295 

155 

76.6 

1912 

207,228 

152 

73.3 

1911 

614,352 

398 

64.8 

1913 

213,983 

181 

84.6 

1912 

631,577 

399 

63.2 

1913 

652,555 

426 

65.3 

Source : 

Vital  Statistics  of  South  Aus- 

tralia. 

Source : 

Vital  Statistics  of  Queensland. 

731 


APPENDIX  G 

Table  278 

Mortality  from  Cancer  in  Queensland,  Males 

1893-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

\esiT 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1893 

233,571 

85 

36.4 

1906 

293,645 

167 

56.9 

1894 

238.940 

88 

36.8 

1907 

295,349 

204 

69.1 

1895 

245,385 

114 

46.5 

1908 

301,323 

189 

62.7 

1909 

310,400 

193 

62.2 

1896 

250,989 

107 

42.6 

1910 

322,268 

233 

72.3 

1897 

255,887 

102 

39.9 

1898 

262,153 

138 

52.6 

1906-1910 

1,522,985 

986 

64.7 

1899 

268,767 

151 

56.2 

1900 

273,288 

130 

47.6 

1911 

334,542 

242 

72.3 

1912 

342,663 

224 

65.4 

1896-1900 

1,311,084 

628 

47.9 

1913 

353,625 

252 

71.3 

1901 

279,075 

163 

58.4 

Source: 

Vital  Statistics  of  Queensland. 

1902 

283,934 

170 

59.9 

1903 

285,176 

156 

54.7 

1904 

288,715 

169 

58.5 

1905 

291,149 

196 

67.3 
59.8 

1901-1905 

1,428,049 

854 

Table  279 

Mortality  from  Cancer  in  Queensland,  Females 

1893-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

\ear 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1893 

180,764 

36 

19.9 

1906 

242,555 

125 

51.5 

1894 

185,552 

69 

37.2 

1907 

247,381 

149 

60.2 

1895 

191,143 

75 

39.2 

1908 

252,296 

148 

58.7 

1909 

259,550 

148 

57.0 

1896 

196,896 

76 

38.6 

1910 

269,323 

162 

60.2 

1897 

202,113 

85 

42.1 

1898 

206,925 

91 

44.0 

1906-1910 

1,271,105 

732 

57.6 

1899 

211,821 

92 

43.4 

1900 

216,793 

99 

45.7 

1911 

279,810 

156 

55.8 

1912 

288,914 

175 

60.6 

1896-1900 

1,034,548 

443 

42.8 

1913 

298,930 

174 

58.2 

1901 

222,357 

115 

51.7 

Source: 

Vital  Statistics  of  Queensland. 

1902 

226,516 

115 

50.8 

1903 

229,307 

96 

41.9 

1904 

233,100 

128 

54.9 

1905 

237,779 

155 

65.2 
53.0 

1901-1905 

1,149,059 

609 

732 


APPENDIX  G 

Table  280 
Mortality  from  Cancer  in  Tasmania,  1884-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1884 

124,971 

65 

52.0 

1901 

172,525 

95 

55.1 

1885 

127,763 

60 

47.0 

1902 

175,173 

109 

62.2 

1903 

180,375 

100 

55.4 

1886 

130,025 

57 

43.8 

1904 

183,007 

93 

50.8 

1887 

133,366 

67 

50.2 

1905 

184,478 

97 

52.6 

1888 

136,709 

68 

49.7 

1889 

139,769 

70 

50.1 

1901-1905 

895,558 

494 

55.2 

1890 

143,224 

79 

55.2 

1906 

184,272 

94 

51.0 

1886-1890 

683,093 

341 

49.9 

1907 

184,791 

112 

60.6 

1908 

187,485 

123 

65.6 

1891 

147,969 

68 

46.0 

1909 

190,227 

124 

65.2 

1892 

150,681 

69 

45.8 

1910 

191,005 

123 

64.4 

1893 

150,304 
151,451 

79 
80 

52.6 
52.8 

1894 

1906-1910 

937,780 

576 

61.4 

1895 

153,701 

75 

48.8 

1911 

190,316 

119 

62.5 

1891-1895 

754,106 

371 

49.2 

1912 

191,684 

132 

68.9 

1913 

195,986 

144 

73.5 

1896 

157,096 

95 

60.5 

1897 

161,629 

81 

50.1 

Source: 

Statistics  of  Tasmania. 

1898 

166,200 

99 

59.6 

Official 

Statistics, 

Commonwealth     of 

1899 

170,400 

91 

53.4 

Australia, 

Commoawealth     Demography, 

1900 

172,631 

93 
459 

53.9 
55.4 

1913. 

1896-1900 

827,956 

Table  281 
Mortality  from  Cancer  in  Tasmania,  Males,  1892-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1892 

79,846 

34 

42.6 

1906 

94,697 

48 

50.7 

1893 

79,267 

40 

50.5 

1907 

94,719 

52 

54.9 

1894 

79,032 

46 

58.2 

1908 

95,852 

60 

62.6 

1895 

79,885 

3*2 

40.1 

1909 
1910 

97,362 
97,552 

55 
61 

56.5 

62.5 

18Q2-1895 

318,030 

152 

47.8 

XKl%fM~l.lJi3%J 

1906-1910 

480,182 

276 

57.5 

1896 

81,585 

49 

60.1 

1897 

83,919 

38 

45.3 

1911 

97,088 

67 

69.0 

1898 

86,669 

52 

60.0 

1912 

98,288 

62 

63.1 

1899 

89,262 

41 

45.9 

1913 

101,469 

69 

68.0 

1900 

90,050 

51 

56.6 

Source: 

Statistics  of  Tasmania 

1896-1900 

431,485 

231 

53.5 

Official 

Statistics, 

Commonwealth     of 

1901 

89,719 

^8 

53.5 

Australia, 
1913. 

Commonwealth     Demography, 

1902 

91,145 

58 

63.6 

1903 

94,135 

55 

58.4 

1904 

95,303 

41 

43.0 

1905 

95,438 

45 

247 

47.2 
53.0 

1901-1905 

465,740 

733 


APPENDIX  G 


Table  282 

Table  283 

Mortality  from  Cancer  in  Tasmania 

Mortality  from  Cancer  in  Western 

Females,  1892-1913 

Rate  per 

} 

Australia,  1881-1913 

Deaths 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1892 

70,835 

35 

49.4 

1881 

29,859 

6 

20.1 

1893 

71,037 

39 

54.9 

1882 

30,586 

9 

29.4 

1894 

72,419 

34 

46.9 

1883 

31,551 

10 

31.7 

1895 

73,816 

43 

58.3 

1884 

32,816 

10 

30.5 

151 

52.4 

1885 

34,753 

17 

48.9 

288,107 

1892-1895 

1881-1885. 

159,565 

52 

32.6 

1896 

75,511 

46 

60.9 

1897 

77,710 

43 

55.3 

1886 

38,282 

15 

39.2 

1898 

79,531 

47 

59.1 

1887 

42,212 

17 

40.3 

1899 

81,138 

50 

61.6 

1888 

43,817 

18 

41.1 

1900 

82,581 

42 

50.9 

1889 

44,737 

20 

44.7 

228 

57.5 

1890 
1886-1890 

47,081 

15 

85 

31.9 

396,471 

1896-1900 

216,129 

39.3 

1901 
1902 
1903 
1904 
1905 

82,806 
84,028 
86,240 
87,704 
89,040 

47 
51 
45 
52 
52 

247 

56.8 
60.7 
52.2 
59.3 
58.4 

57.5 

1891 
1892 
1893 
1894 
1895 

1891-1895 

50,840 
55,873 
61,746 
73,251 
91,047 

20 
16 
19 

22 
25 

102 

39.3 

28.6 
30.8 
30.0 

27.5 

429,818 

1901-1905 

332,757 

30.7 

1906 

89,575 

46 

51.4 

1896 

118,666 

30 

25.3 

1907 

90,072 

60 

66.6 

1897 

148,656 

51 

34.3 

1908 

91,633 

63 

68.8 

1898 

163,687 

55 

33.6 

1909 

92,865 

69 

74.3 

1899 

168,568 

60 

35.6 

1910 

93,453 

62 
300 

66.3 
65.6 

1900 
1896-1900 

175,113 

52 

248 

29.7 

1906-1910 

457,598 

774,690 

32.0 

1911 

93,228 

52 

55.8 

1901 

188,135 

83 

44.1 

1912 

93,396 

70 

74.9 

1902 

204,705 

85 

41.5 

1913 

94,517 

75 

79.4 

1903 

219,643 

92 

41.9 

1904 

233,963 

105 

44.9 

Source: 

Statistics  of  Tasmania 

1905 

246,681 

127 

51.5 

Official 

Statistics 

r"r,mmrvnwealt>i        r.f 

Australia, 

Commonwealth     Demography, 

1901-1905 

1,093,127 

492 

45.0 

1913. 

1906 

254,362 

154 

60.5 

1907 

255,510 

131 

51.3 

1808 

257,822 

140 

54.3 

1909 

263,279 

182 

69.1 

1910 
1906-1910 

271,019 

135 

742 

49.8 

1,301,992 

57.0 

1911 

286,807 

177 

61.7 

1912 

301,426 

180 

59.7 

1913 

314,178 

178 

56.7 

Source: 

Statistical  Register  of  Western 

Australia. 

734 


APPENDIX  G 

Table  284 
Mortality  from  Cancer  in  Western  Australia,  Males,  1897-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1897 

102,327 

37 

36.2 

1906 

148,501 

91 

61.3 

1898 

107,62-i 

39 

36.2 

1907 

147,641 

79 

53.5 

1899 

107,204 

41 

38.2 

1908 

147,918 

77 

52.1 

1900 

108,452 

33 

30.4 

1909 

150,400 

97 

64.5 

1910 

154,467 

74 

47.9 

1897-1900 

425,607 

150 

35.2 

1906-1910 

748,927 

418 

55.8 

1901 

115,080 

53 

46.1 

1902 

124,839 

46 

36.8 

1911 

164,136 

109 

66.4 

1903 

132,272 

44 

33.3 

1912 

172,098 

106 

61.6 

1904 

139,338 

61 

43.8 

1913 

178,265 

92 

51.6 

1905 

145,471 

74 

50.9 

Source: 

Statistical 

Register  of 

Westera 

1901-1905 

657,000 

278 

42.3 

Australia. 

Table  285 
Mortality  from  Cancer  in  Western  Australia,  Females,  1897-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1897 

46,329 

14 

30.2 

1906 

105,861 

63 

59.5 

1898 

56,063 

16 

28.5 

1907 

107,869 

52 

48.2 

1899 

61,364 

19 

31.0 

1908 

109,904 

63 

57.3 

1900 

66,661 

19 

28.5 

1909 

112,879 

85 

75.3 

1910 

116,552 

61 

52.3 

1897-1900 

230,417 

68 

29.5 

1906-1910 

553,065 

324 

58.6 

1901 

73,055 

30 

41.1 

1902 

79,866 

39 

48.8 

1911 

122,671 

68 

55.4 

1903 

87,371 

48 

54.9 

1912 

129,328 

74 

57.2 

1904 

f      94,625 

44 

46.5 

1913 

135,913 

86 

63.3 

1905 

101,210 

53 

52.4 

Source: 

Statistical 

Register  of 

Western 

1901-1905 

436,127 

214 

49.1 

Australia. 

Table  286 
Mortality  from  Cancer,  Northern  Territory,  Commonwealth  of  Australia 

1911-1913 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1911 

3,319 

1 

30.1 

1912 

3,359 

2 

59.5 

1913 

3,360 

2 
5 

54.6 

11-1913 

10,038 

49.8 

Source:  Official  Statistics,  Common- 
wealth of  Australia,  Commonwealth  De- 
mography, 1911-1913. 


735 


APPENDIX  G 


Table  287 

Table  288 

Mortality  from  Cancer  in  New  Zea- 

Mortality  from  Cancer  in  New  Zea- 

land,  1881 

-1913 

Deaths 

Rate  per 

la 

Qd,  Males, 

1889-1913 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

493,482 

134 

27.2 

1889 

325,249 

144 

44.3 

1882 

509,309 

147 

28.9 

1890 

330,069 

156 

47.3 

1883 

529,292 

158 

29.9 

1884 

552,590 

191 

34.6 

1891 

334,366 

154 

46.1 

1885 

573,362 

177 

30.9 

1892 

340,660 

173 

50.8 

1893 
1894 

351,391 
360,699 

188 
240 

53.5 
66.5 

1881-1885 

2,658,035 

807 

30.4 

1886 

582,117 

214 

36.8 

1895 

366,744 

208 

56.7 

1887 

596,374 

238 

39.9 

1891-1895 

1,753,860 

963 

54.9 

1888 

605,371 

263 

43.4 

1889 

611,716 

260 

42.5 

1896 

373,238 

205 

54.9 

1890 

620,780 

295 

47.5 

1897 

380,845 

210 

55.1 

1898 
1899 

388,414 
395,402 

263 
271 

67.7 
68.5 

1886-1890 

3,016,358 

1,270 

42.1 

1900 

402,118 

246 

61.2 

1891 

629,783 
642,245 

295 

46.8 

1892 

307 

47.8 

1896-1900 

1,940,017 

1,195 

61.6 

1893 

661,349 

332 

50.2 

1894 

679,196 

408 

60.1 

1901 

408,926 

265 

64.8 

1895 

692,417 

383 

55.3 

1902 

420,065 

296 

70.5 

1903 

432,791 

325 

75.1 

1891-1895 

3,304,990 

1,725 

52.2 

1904 

446,833 

323 

72.3 

1905 

460,679 

313 

67.9 

1896 

706,846 
721,609 

389 

55.0 

1897 

395 

54.7 

1901-1905 

2,169,294 

1,522 

70.2 

1898 

736,260 

471 

64.0 

1899 

749,984 

468 

62.4 

1906 

474,509 

337 

71.0 

1900 

763,594 

430 

56.3 

1907 

487,150 

361 

74.1 

1908 

501,489 

363 

72.4 

1896-1900 

3,678,293 

2,153 

58.5 

1909 

515,368 

389 

74.3 

1901 

777,968 
797,793 
820,217 

515 
536 

582 

66.2 
67.2 
71.0 

1910 
1906-1910 

525,167 

399 

76.0 

1902 
1903 

2,503,683 

1,843 

73.6 

1904 

845,022 

571 

67.6 

1911 

534,863 

448 

83.8 

1905 

870,000 

566 

65.1 

67.4 

1912 
1913 

546,873 
561,160 

418 
446 

76.4 

1901-1905 

4,111,000 

2,770 

79.5 

1906 

895,594 

623 

69.6 

Source: 

Statistics  of  the  Colony  of  New 

1907 

919,105 

674 

73.3 

Zealand. 

1908 

945,063 

657 

69.5 

1909 

971,784 

711 

73.2 

1910 

992,802 

742 

74.7 
72.1 

1906-1910 

4,724,348 

3,407 

1911 

1,014,896 

809 

79.7 

1912 

1,039,017 

812 

78.2 

1913 

1,068,644 

854 

79.9 

Source: 

Statistics  of  the  Colony  of  New 

Zealand. 

736 


APPENDIX  G 

Table  289 

Mortality  from  Cancer  in  New  Zealand,  Females 

1889-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1889 

286,467 

116 

40.5 

1906 

421,085 

286 

67.9 

1890 

290,711 

139 

47.8 

1907 

431,955 

313 

72.5 

1908 

443,574 

294 

66.3 

1891 

295,417 

141 

47.7 

1909 

456,416 

328 

71.9 

1892 

301,585 

134 

44.4 

1910 

467,635 

343 

73.3 

1893 

309,958 

144 

46.5 

1894 

318,497 

168 

52.7 

1906-1910 

2,220,665 

1,564 

70.4 

1895 

325,673 

175 

53.7 

1911 

480,033 

361 

75.2 

1891-1895 

1,551,130 

762 

49.1 

1912 

492,144 

394 

80.1 

1913 

507,484 

408 

80.4 

1896 

333,608 

184 

55.2 

1897 

340,764 

185 

54.3 

Source : 

Statistics 

of    the 

Colony    of 

1898 

347,846 

208 

59.8 

New  Zealand. 

1899 

354,582 

197 

55.6 

1900 

361,476 

184 

50.9 
55.1 

1896-1900 

1,738,276 

958 

1901 

369,042 

250 

67.7 

1902 

377,728 

240 

63.5 

1903 

387,426 

257 

66.3 

1904 

398,189 

248 

62.3 

1905 

409,321 

253 

61.8 
64.3 

1901-1905 

1,941,706 

1,248 

Table  290 

Cases  of  Cancer  in  the  Colonial  Hospital,  Fiji 

1898-1911 


Rate  per 

Rate  per 

Total 

Cases  of 

1,000 

Total 

Cases  of        1,000 

Year 

Admissions 

Cancer 

Admissions 

Year 

Admissions 

Cancer     Admissions 

1898 

1,147 

2 

1.7 

1906 

1,356 

8              5.9 

1899 

1,407 

5 

3.6 

1907 

1,731 

4              2.3 

1900 

1,427 

8 

5.6 

1908 

1,627 

9              5.5 

1909 

1,810 

8              4.4 

1898-1900 

3,981 
1,222 

15 

2 

3.8 
1.6 

1911 
1906-1911* 

2,120 

7              3.3 

1901 

8,644 

36              4.2 

1902 

1,272 

4 

3.1 

1903 

1,773 

13 

7.3 

Source: 

Fiji,  Annual  Medical  Reports. 

1904 

1,485 

19 

12.8 

*Data  for  1910  unobtainable 

1905 

1,398 

8 
46 

5.7 
6.4 

1901-1905 

7,150 

737 


APPENDIX  G 

Table  291 
Cases  of  Cancer  in  the  Colonial  Hospital,  Fiji,  by  Organs  and  Parts 

1905-1911* 


Carcinoma  of  Cases 

ffisophagus 1 

Stomach 3 

Pylorus 5 

Pancreas 1 

Liver 8 

Gall-bladder 2 

Intestines 1 

Rectum 2 

Prostate 1 

Breast 1 

Uterus 8 

Other  or  not  specified 2 

Epithelioma 4 

Sarcoma 5 

AH  organs 44 

Source:    Fiji,  Annual  Medical  Reports. 

*Data  for  1910  unobtainable. 


Per  Cent. 
2.3 

6.8 

11.4 
2.3 

18.2 
4.5 
2.3 
4.5 
2.3 
2.3 

18.2 
4.5 
9.0 

11.4 


100.0 


Table  292 

Cases  of  Cancer  in  thie  Colonial  Hospital,  Fiji,  by  Race 

1906-1911* 

Rate  per 
Total  Cases  of  1,900 

Admissions  Cancer  Admissions 

Europeans 845  8  9.5 

Fijians 2,991  4  1.3 

Polynesians 825  1  1.2 

East  Indians 3,838  20  5.2 

Miscellaneous 313  3  9.6 

Total 8,812  36  4.1 

Source:     Fiji,  Annual  Medical  Reports. 

Note:     The  number  of  admissions  given  above  includes  168  admissions  from  previous 
years. 

*Data  for  1910  unobtainable. 


738 


APPENDIX  G 


Table  293 

Mortality  from  Cancer  in  Hawaii 

1902-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1902 

161,581 

22 

13.6 

1906 

176,745 

44 

24.9 

1903 

165,372 

38 

23.0 

1907 

180,536 

47 

26.0 

1904 

169,163 

41 

24.2 

1908 

184,327 

58 

31.5 

1905 

172,954 

44 

25.4 

1909 

188,118 

69 

36.7 

1910 

193,014 

95 

49  2 

1902-1905 

669,070 

145 

21.7 

1906-1910 

922,740 

313 

33.9 

1911 

196,805 

99 

50.3 

1912 

200,596 

71 

35.4 

1913 

217,744 

100 

45.9 

Source: 

Report  of  the  President  of  the 

Board  of  Health  of  the  Territory  of  Hawaii. 

Table  294 

Mortality  from  Cancer  in  the  Territory  of  Hawaii,  by  Race 

July  1,  1911,  to  June  30,  1913 


Race  Population 

Hawaiian 54,386 

Part  Hawaiian 26,131 

Portuguese 46,571 

Chinese 45,268 

Japanese 166,404 

All  others 62,020 

Total 400,780 

Source:     Annual  Reports  of  the  Registrar-General  of  Hawaii. 


Deaths 

from 

Cancer 

51 

7 
27 
12 
33 
23 

153 


Rate  per 

100,000 

Population 

93.8 
26.8 
58.0 
26.5 
19.8 
37.1 

38.2 


Table  295 

Proportionate  Mortality  from  Cancer  in  the  Territory  of  Hawaii 

according  to  Race,  by  Organs  and  Parts 

July  1,  1911,  to  June  30,  1913 


Haw 

AIIANS 

Portuguese 

Chinese 

Japanese 

Organ  or  Part 

Deaths 

Per  Cent. 

Deaths      Per  Cent. 

Deaths 

Per  Cent. 

Deaths   Per  Cent. 

Breast 

7 

13.7 

1             3.7 

0.0 

0.0 

Face 

0.0 

0.0 

1 

8.3 

0.0 

Intestines 

...          1 

2.0 

0.0 

0.0 

4           12.1 

Liver 

5 

9.8 

4           14.8 

1 

8.3 

1             3.0 

Stomach 

...      14 

27.5 

11           40.8 

6 

50.0 

19           57.6 

Uterus 

...      15 

29.4 

2             7.4 

2 

16.7 

6           18.2 

Other  organs .... 

9 
...     51 

17.6 

9           33.3 

2 
12 

16.7 

3             9.1 

All  organs 

100.0 

27         100.0 

100.0 

33         100.0 

Source:    Annual  Reports  of  the  Registrar-General  of  Hawaii. 


739 


APPENDIX  G 

Table  296 
Mortality  from  Cancer  in  Countries  of  America 


Deaths  Rate  per 

Population  from  100,000 

Cancer  Population 

Argentina 17,807,056  11,392  64.0 

Bermuda 92,780  52  56.0 

Bolivia 316,090  69  21.8 

Brazil 9,384,279  3,145  33.5 

British  Guiana 1,487,922  271  18.2 

British  Honduras 197,820  29  14.7 

British  West  Indies 6,897,104  1,439  20.9 

Canada 19,689,825  12,208  62.0 

Chile 17,047,786  6,077  35.6 

Colombia 242,986  218  89.7 

Costa  Rica 1,849,534  751  40.6 

Cuba 10,892,077  4,855  44.6 

Danish  West  Indies 53,393  63  118.0 

Dutch  Guiana 174,775  167  95.6 

Ecuador 200,000  122  61.0 

Mexico 2,355,330  1,165  49.5 

Newfoundland 1,192,843  616  51.6 

Nicaragua 2,180,000  231  10.6 

Peru 170,000  202  118.8 

Salvador 357,240  208  58.2 

United  States 271,207,437  202,621  74.7 

Uruguay 5,421,854  3,577  66.0 

Venezuela 13,331,180  1,960  14.7 

Total 382,549,311  251,438  65.7 

Population,  1911:  82,835,662. 
Note:  Argentina Province  of  Buenos  Aires,  1908-1912,  City  of  Buenos  Aires,  1907, 

1911,  City  of  Rosario  de  Santa  Fe,  1907-1911,  Province  of  Tucu- 
man,  1906-1910,  City  of  Santiago  del  Estero,  1904-1908 

Bermuda 1906-1910 

Bohvia City  of  La  Paz,  1901-1905 

Brazil Federal  District  of  Rio  de  Janeiro,   1906-1910,   State  of  Parana, 

1906  1910,  City  of  Bahia,  1907-1911,  City  of  Sao  Paulo,  1908- 

1912,  City  of  Pelotas,  1906-1907,  1909-1911,  City  of  Belle 
Horizonte,  1910-1912 

British  Guiana 1908-1912 

British  Honduras 1906-1910 

British  West  Indies ..  Jamaica,  1908-1912,  Trinidad,   1907-1911,  British  Windward  and 

Leeward  Islands,  1907-1911 
Canada Province  of  Ontario,   1908-1912,   Province  of  Nova  Scotia,   1910- 

1913,  Province  of  Prince  Edward  Island,  1913,  Province  of 
British  Columbia,  1909-1913,  City  of  Montreal,  1908-1912,  City 
of  Quebec,  1908-1912,  City  of  Wimiipeg,  1910-1912,  City  of  St. 
John,  N.  B.,  1908-1912 

Chile 1908-1912 

Colombia City  of  Bogota,  1912-1913 

Costa  Rica 1908-1912 

Cuba 1908-1912 

Danish  West  Indies.  .Island  of  St.  Thomas,  1909-1913 

Dutch  Guiana City  of  Paramaribo,  1908-1912 

Ecuador City  of  Guayaquil,  1910-1912 

Mexico City  of  Mexico,  1908-1912 

Newfoundland 1907-1911 

Nicaragua 1908-1911 

Salvador City  of  San  Salvador,  1908-1913 

Peru City  of  Lima,  1904,  City  of  Trujillo,  1909-1913 

United  States Registration  Area,  1908-1912 

Uruguay 1907-1911 

Venezuela 1906-1910 

740 


APPENDIX  G 


Table 

297 

Table  298 

Mortality  from  Cancer  in  the  Prov- 

Mortality from  Cancer  in  Toronto 

ince  of  Ontario,  Canada 

Province  of  Ontario 

1881-1913 

Rate  per 

1881-1913 

Deaths 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

1,923,228 

313 

16.3 

1881 

86,415 

23 

26.6 

1882 

1,942,337 

397 

20.4 

1882 

92,175 

25 

27.1 

1883 

1,961,446 

403 

20.5 

1883 

97,935 

24 

24.5 

1884 

1,980,555 

422 

21.3 

1884 

103,696 

37 

35.7 

1885 

1,999,664 

463 

23.2 
20.4 

1885 
1881-1885 

109,457 

49 

44.8 

1881-1885 

9,807,230 

1,998 

489,678 

158 

32.3 

1886 

2,018,773 

440 

21.8 

1886 

115,218 

55 

47.7 

1887 

2,037,882 

614 

30.1 

1887 

120,979 

59 

48.8 

1888 

2,056,991 

635 

30.9 

1888 

126,740 

76 

60.0 

1889 

2,076,100 

714 

34.4 

1889 

132,501 

93 

70.2 

1890 

2,095,209 

685 

32.7 
30.0 

1890 
1886-1890 

138,262 

78 

56.4 

1886-1890 

10,284,955 

3,088 

633,700 

361 

57.0 

1891 

2,114,321 

579 

27.4 

1891 

144,023 

74 

51.4 

1892 

2,121,183 

676 

31.9 

1892 

150,424 

87 

57.8 

1893 

2,128,045 

678 

31.9 

1893 

156,825 

106 

67.6 

1894 

2,134,907 

621 

29.1 

1894 

163,226 

85 

52.1 

1895 

2,141,769 

620 

28.9 
29.8 

1895 
1891-1895 

169,628 

112 

66.0 

1891-1895 

10,640,225 

3,174 

784,126 

464 

59.2 

1896 

2,148,632 

731 

34.0 

1896 

176,030 

116 

65.9 

1897 

2,155,495 

927 

43.0 

1897 

182,432 

114 

62.5 

1898 

2,162,358 

975 

45.1 

1898 

188,834 

129 

68.3 

1899 

2,169,221 

1,041 

48.0 

1899 

195,236 

134 

68.6 

1900 

2,176,084 

1,055 

48.5 
43.7 

1900 
1896-1900 

201,638 

171 

84.8 

1896-1900 

10,811,790 

4,729 

944,170 

664 

70.3 

1901 

2,182,947 

1,094 

50.1 

1901 

208,040 

163 

78.4 

1902 

2,216,979 

1,048 

47.3 

1902 

224,889 

133 

59.1 

1903 

2,251,011 

1,156 

51.4 

1903 

241,738 

157 

64.9 

1904 

2,285,043 

1,253 

54.8 

1904 

258,588 

187 

72.3 

1905 

2,319,076 

1,224 

52.8 
51.3 

1905 
1901-1905 

275,438 

191 

69.3 

1901-1905 

11,255,056 

5,775 

1,208,693 

831 

68.8 

1906 

2,353,109 

1,411 

60.0 

1906 

292,288 

187 

64.0 

1907 

2,387,142 

1,329 

55.7 

1907 

309,138 

204 

66.0 

1908 

2,421,175 

1,348 

55.7 

1908 

325,988 

203 

62.3 

1909 

2,455,208 

1,597 

65.0 

1909 

342,838 

259 

75.5 

1910 

2,489,241 

1,587 

63.8 
60.1 

1910 
1906-1910 

359,688 

270 

75.1 

1906-1910 

12,105,875 

7,272 

1,629,940 

1,123 

68.9 

1911 

2,523,274 

1,602 

63.5 

1911 

376,538 

255 

67.7 

1912 

2,560,000 

1,778 

69.5 

1912 

393,388 

326 

82.9 

1913 

2,600,960 

1,806 

69.4 

1913 

410,238 

336 

81.9 

Source: 

Reports  Relating  to  the  Regis- 

Source: 

Reports  Relating  to 

the  Regis- 

tration  of 

Births,   Marriages  and  Deaths 

tration  of 

Births,  Marriages  and  Deaths 

in  the  Province  of  Ontario,  1881-1913. 

in  the  Province  of  Ontario,  1881-1913. 

741 


APPENDIX  G 


Table  299 

Table  300 

Mortality  from  Cancer  in  Toronto 

Mortality  from  Cancer  in  Toronto 

] 

Males,  1881- 

-1913 

Deaths 

Rate  per 

I 

"emales,  1881-1913 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

41,917 

8 

19.1 

1881 

44,498 

15 

33.7 

1882 

44,696 

14 

31.3 

1882 

47,479 

11 

23.2 

1883 

47,469 

15 

31.6 

1883 

50,466 

9 

17.8 

1884 

50,241 

14 

27.9 

1884 

53,455 

23 

43.0 

1885 

53,010 

22 
73 

41.5 
30.8 

1885 
1881-1885 

56,447 

27 
85 

47.8 

1881-1885 

237,333 

252,345 

33.7 

1886 

55,777 

22 

39.4 

1886 

59,441 

33 

55.5 

1887 

58,542 

25 

42.7 

1887 

62,437 

34 

54.5 

1888 

61,291 

35 

57.1 

1888 

65,449 

41 

62.6 

1889 

64,038 

34 

53.1 

1889 

68,463 

59 

86.2 

1890 

66,781 

29 
145 

43.4 
47.3 

1890 
1886-1890 

71,481 

49 

216 

68.5 

1886-1890 

306,429 

327,271 

66.0 

1891 

69,520 

33 

47.5 

1891 

74,503 

41 

55.0 

1892 

72,384 

28 

38.7 

1892 

78,040 

59 

75.6 

1893 

75,213 

45 

59.8 

1893 

81,612 

61 

74.7 

1894 

78,022 

26 

33.3 

1894 

85,204 

59 

69.2 

1895 

80,811 

49 
181 

60.6 

48.1 

1895 
1891-1895 

88,817 

63 

283 

70.9 

1891-1895 

375,950 

408,176 

69.3 

1896 

83,579 

55 

65.8 

1896 

92,451 

61 

66.0 

1897 

86,327 

44 

51.0 

1897 

96,105 

70 

72.8 

1898 

89,054 

62 

69.6 

1898 

99,780 

67 

67.1 

1899 

91,761 

53 

57.8 

1899 

103,475 

81 

78.3 

1900 

94,447 

65 
279 

68.8 
62.7 

1900 
1896-1900 

107,191 

106 
385 

98.9 

1896-1900 

445,168 

499,002 

77.2 

1901 

97,113 

60 

61.8 

1901 

110,927 

103 

92.9 

1902 

105,585 

52 

49.2 

1902 

119,304 

81 

67.9 

1903 

114,149 

68 

59.6 

1903 

127,589 

89 

69.8 

1904 

122,803 

71 

57.8 

1904 

135,785 

116 

85.4 

1905 

131,549 

84 
335 

63.9 
58.6 

1905 
1901-1905 

143,889 

107 
496 

74.4 

1901-1905 

571,199 

637,494 

77.8 

1906 

140,386 

76 

54.1 

1906 

151,902 

111 

73.1 

1907 

149,314 

80 

53.6 

1907 

159,824 

124 

77.6 

1908 

158,332 

78 

49.3 

1908 

167,656 

125 

74.6 

1909 

167,442 

123 

73.5 

1909 

175,396 

136 

77.5 

1910 

176,643 

119 
476 

67.4 
60.1 

1910 
1906-1910 

183,045 

151 
647 

82.5 

1906-1910 

792,117 

837,823 

77.2 

1911 

185,934 

99 

53.2 

1911 

190,604 

156 

81.8 

1912 

194,257 

130 

66.9 

1912 

199,131 

196 

98.4 

1913 

202,575 

129 

63.7 

1913 

207,663 

207 

99.7 

Source: 

Reports  Relating  to  the  Regis- 

Source: 

Reports  Relating  to  the  Regis- 

tration  of 

Births,  Marriages  and   Deaths 

tration  of  Births,  Marriages  and  Deaths 

in  the  Province  of  Ontario,  1881 

-1913. 

in  the  Province  of  Ontario,  1881- 

1913. 

742 


APPENDIX  G 

Table  301 

Mortality  from  Cancer  in  the  City  of  Montreal 

1881-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

115,238 

46 

•      39.9 

1906 

369,105 

213 

57.7 

1882 

125,675 

65 

51.7 

1907 

389,380 

234 

60.1 

1883 

136,112 

63 

46.3 

1908 

409,655 

230 

56.1 

1884 

146,550 

59 

40.3 

1909 

429,930 

267 

62.1 

1885 

156,988 

79 

50.3 
45.8 

1910 
1906-1910 

450,205 

292 

64.9 

1881-1885 

680,563 

312 

2,048,275 

1.236 

60.3 

1886 

167,426 

85 

50.8 

1911 

470,480 

309 

65.7 

1887 

177,864 

75 

42.2 

1912 

488,400 

331 

67.8 

1888 

188,302 

87 

46.2 

1913 

515,700 

283 

54.9 

1889 

198,740 

97 

48.8 

1890 

209,178 

74 

35.4 

Source: 

1881-1890, 

Statistique  Demo- 

graphique 

des  Grandes  Villes  d 

i\/f"      J 

\i  Monde, 

1886-1890 

941,510 

418 

44.4 

No.  40. 

Amsterdam, 

1912. 

Reports 

on  the  Sanitary  State  of  the 

1891 

219,616 

99 

45.1 

City  of  Montreal,  1891-1913. 

1892 

224,427 

109 

48.6 

1893 

229,238 

100 

43.6 

1894 

234,049 

114 

48.7 

1895 

238,860 

117 

49.0 

47.0 

1891-1895 

1,146,190 

539 

1896 

243,672 

133 

54.6 

1897 

1898 

253,296 

182 

71.9 

1899 

258,108 

190 

73.6 

1900 

262,920 

146 

55.5 
63.9 

1896-1900 

1,017,996 

651 

1901 

267,730 

196 

73.2 

1902 

288,005 

158 

54.9 

^ 

1903 

308,280 

206 

66.8 

1904 

328,555 

180 

54.8 

1905 

348,830 

167 

47.9 

58.8 

1901-1905 

1,541,400 

907 

743 


APPENDIX  G 


Table  302 

Mortality  from  Cancer  in  the  City  of  Quebec 

1894-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1894 

64,815 

28 

43.2 

1906 

72,034 

25 

34.7 

1895 

65,390 

16 

24.5 

1907 

74,390 

39 

52.4 

1908 

73,333 

33 

45.0 

1896 

65,965 

20 

30.3 

1909 

76,000 

42 

55.3 

1897 

66,540 

23 

34.6 

1910 

77,100 

44 

57.1 

1898 

67,115 

32 

47.7 

1899 

67,690 

27 

39.9 

1906-1910 

372,857 

183 

49.1 

1900 

68,265 

34 

49.8 

IQIl 

78,190 

79,280 

'l^ 

65.2 
56.8 

1896-1900 

335,575 

136 

40  5 

li7  JL  L 

1912 

\j  ± 
45 

1901 

68,840 

38 

55.2 

Source: 

Annual  Reports  of  the  Board  of 

1902 

69,595 

44 

63.2 

Health  of  the  Province  of  Quebec. 

1903 

70,204 

38 

54.1 

1904 

70,819 

31 

43.8 

1905 

71,439 

30 
181 

42.0 
51.6 

1901-1905 

350,897 

Table  303 

Mortality  from  Cancer  in  the  City  of  Winnipeg,  by  Sex 

1910-1913 


TOTAL 

]MALES 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1910 

127,555 

64 

50.2 

1910 

69,773 

36 

51.6 

1911 

142.339 

71 

49.9 

1911 

77,859 

31 

39.8 

1912 

159,256 

82 

51.5 

1912 

87,113 

39 

44.8 

1913 

177,433 

95 
312 

53.5 
51.4 

1913 
1910-1913 

97,056 

46 
152 

47.4 

1910-1913 

606,583 

331,801 

45.8 

FEMi 

^ES 

Year 

Population 

Deaths 
from 
Cancer 

Ratetper 

100,000 

Population 

1910 

57,782 

28 

48.5 

1911 

64,480 

40 

62.0 

1912 

72,143 

43 

59.6 

1913 
1910-1913 

80,377 

49 
160 

61.0 

58.2 

274,782 

Source:  City  of  Winnipeg,  Report  of 
the  Department  of  Pubhc  Health,  1910- 
1913. 


744 


APPENDIX  G 


Table  304 
Mortality  from  Cancer  in  British  Columbia,  1901-1913 


Year 

Population 

Deaths 

from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 

from 
Cancer 

Rate  per 

100,000 

Population 

1901 
1902 
1903 
1904 
1905 

175,657 
197,340 
219,023 
240,706 
262,388 

49 
81 
73 
66 
63 

332 

27.9 
41.0 
33.3 
27.4 
24.0 

30.3 

1906 
1907 
1908 
1909 
1910 

1906-1910 

284,070 
305,752 
327,434 
349,116 
370,798 

71 
101 

99 
123 
152 

546 

25.0 
33.0 
30.2 
35.2 
41.0 

1901-1905 

1,095,114 

1,637,170 

33.4 

1911 
1912 
1913 

392,480 
414,162 
435,844 

148 
180 
159 

37.7 
43.5 
36.5 

Source:     Annual  Reports  of  the  Regis- 
trar of  Births,  Deaths  and  Marriages  for 
the  Province  of  British  Columbia. 

Table  305 
Mortality  from  Cancer  in  the  Prov- 
ince of  Nova  Scotia,  by  Sex 
1910-1913 


TOTAL 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Cancer 

Population 

1910 

486,870 

349 

71.7 

1911 

492,338 

371 

75.4 

1912 

496,423 

378 

76.1 

1913 

501,751 

348 

69.4 

10-1913 

1,977,382 

MALES 

1,446 

73.1 

1910 

248,304 

170 

68.5 

1911 

251,019 

179 

71.3 

1912 

253,176 

171 

67.5 

1913 

255,893 

159 

62.1 

1910-1913     1,008,392  679 

FEMALES 


1910 
1911 
1912 
1913 


238,566 
241,319 
243,247 
245,858 


179 
192 

207 
189 


1910-1913   968,990 


767 


67.3 


75.0 
79.6 
85.1 
76.9 

79.2 


Source:  Reports  of  the  Deputy  Regis- 
trar-General Relating  to  the  Registration 
of  Births,  Marriages  and  Deaths  in  Nova 
Scotia,  1910-1913. 


Table  306 

Mortality  from  Cancer  in  the 

Province  of  Prince  Edward  Island 

1913-1914 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1913 

92,000 

54 

58.7 

1914 

90,631 

46 
100 

50.8 

1913-1914 

182,631 

54.7 

Source:  Report  of  the  Registrar- 
General  of  Births,  Marriages  and  Deaths 
of  the  Province  of  Prince  Edward  Island. 


745 


APPENDIX  G 

Table  307 
Mortality  from  Cancer  in  the  City  of  St.  John,  Province  of  New  Brunswick 


1891- 

1913 

Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1891 

39,179 

9 

23.0 

1906 

41,611 

37 

88.9 

1892 

39,332 

18 

45.8 

1907 

41,791 

34 

81.4 

1893 

39,485 

15 

38.0 

1908 

41,971 

29 

69.1 

1894 

39,638 

26 

65.6 

1909 

42,151 

32 

75.9 

1895 

39,791 

32 
100 

80.4 
50.7 

1910 
1906-1910 

4.2,331 

36 
168 

85.0 

1891-1895 

197,425 

209,855 

80.1 

1896 

39,944 

32 

80.1 

1911 

42,511 

36 

84.7 

1897 

40,097 

29 

72.3 

1912 

42,691 

40 

93.7 

1898 

40,250 

35 

87.0 

1913 

42,871 

38 

88.6 

1899 

40,403 

24 

59.4 

1900 

40,556 

38 

93.7 

Source: 

Annual  Reports  of  the  Provincial 

Board  of  Health  of  New  Brunswick. 

1896-1900 

201,250 

158 

78.5 

1901 

40,711 

44 

108.1 

1902 

40,891 

37 

90.5 

1903 

41,071 

37 

90.1 

1904 

41,251 

39 

94.5 

1905 

41,431 

43 
200 

103.8 
97.4 

1901-1905 

205,355 

Table  308 

Mortality  from  Cancer  in  the 

Colony  of  Newfoundland 

and  Labrador 

1906-1913 


Year 

1906 
1907 
1908 
1909 
1910 


Population 

231,974 
234,172 
236,370 
238,568 
240,767 


1906-1910  1,181,851 


595 


1911  242,966  137 

1912  243,928  118 

1913  246,397  111 


Rate  per 

100,000 

Population 

50.0 
47.0 
55.8 
51.6 
47.3 

50.3 

56.4 
48.4 
45.0 


Source:  Annual  Reports  of  the  Regis- 
trar-General of  Births,  Marriages  and 
Deaths  of   Newfoundland   for  1906-1913. 


746 


APPENDIX  G 

Table  309 
Mortality  from  Cancer  in  the  Bermuda  Islands,  1891-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1891 

15,013 

6 

40.0 

1906 

18,264 

11 

60.2 

1892 

15,265 

14 

91.7 

1907 

18,410 

8 

43.5 

1893 

15,517 

8 

51.6 

1908 

18,556 

10 

53.9 

1894 

15,769 

10 

63.4 

1909 

18,702 

16 

85.6 

1895 

16,021 

5 
43 

31.2 
55.4 

1910 
1906-1910 

18,848 

7 
52 

37.1 

1891-1895 

77.585 

92,780 

56.0 

1896 

16,273 

9 

55.3 

1911 

18,994 

6 

31.6 

1897 

16,525 

4 

24.2 

1912 

19,392 

12 

61.9 

1898 

16,777 

13 

77.5 

1913 

19,790 

13 

65.7 

1899 

17,029 

12 

70.5 

1900 

17,281 

13 

75.2 

Source: 

Bermuda,  Reports  of  the  Regis- 

froT-   noncTol      1C01     lOia 

1896-1900 

83,885 

51 

60.8 

Lrar-vieiier 

a.1,    njn  i.-i~a  i.%j. 

1901 

17,535 

9 

51.3 

1902 

17,680 

9 

50.9 

1903 

17,826 

11 

61.7 

1904 

17,972 

15 

83.5 

1905 

18,118 

12 
56 

66.2 

62.8 

1901-1905 

89,131 

Table  310 
Mortality  from  Cancer  in  the  Bermuda  Islands,  Males,  1891-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1891 

7,036 

2 

28.4 

1906 

8,840 

4 

45.2 

1892 

7,193 

3 

41.7 

1907 

8,886 

4 

45.0 

1893 

7,350 

3 

40.8 

1908 

8,932 

3 

33.6 

1894 

7,507 

3 

40.0 

1909 

8,978 

7 

78.0 

1895 

7,664 

1 
12 

13.0 
32.7 

1910 
1906-1910 

9,024 

3 
21 

33.2 

1891-1895 

36,750 

44,660 

47.0 

1896 

7,821 

3 

38.4 

1911 

9,070 

4 

44.1 

1897 

7,978 

1 

12.5 

1912 

9,283 

6 

64.6 

1898 

8,135 

4 

49.2 

1913 

9,497 

6 

63.2 

1899 

8,292 

4 

48.2 

1900 

8,449 

3 

35.5 

Source: 

Bermuda,  Reports  of  the  Regis- 

trar-General,  1891-1913. 

1896-1900 

40,675 

15 

36.9 

1901 

8,606 

3 

34.9 

1902 

8,656 

4 

46.2 

1903 

8,702 

3 

34.5 

1904 

8,748 

7 

80.0 

1905 

8,794 

5 

22 

56.9 
50.6 

1901-1905 

43,506 

747 


APPENDIX  G 


Table  311 

Table  312 

Mortality  from  Cancer 

in 

the  Ber- 

Mortality  from  Cancer  in  Jamaica 

muda  Islands, 

Females 

1881-1913 

l»Vl-lVliJ 

X^eatns 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 

Rate  per 
100,000 

Year 

Population 

from 
Cancer 

Cancer 

Population 

1881 

580,804 

57 

9.8 

1891 

7,977 

4 

50.1 

1882 

688,718 

43 

7.3 

1892 

8,072 

11 

136.3 

1883 

594,023 

65 

10.9 

1893 

8,167 

5 

61.2 

1884 

591,819 

66 

11.2 

1894 

8,262 
8,357 

7 
4 

84.7 
47.9 

1885 

596,383 

64 

10.7 

1895 

1881-188') 

2,951,747 

295 

10.0 

1891-1895 

40,835 

31 

75.9 

XOOAXOOi^ 

1886 

603,354 

65 

10.8 

1896 

8,452 

6 

71.0 

1887 

603,500 

61 

10.1 

1897 

8,547 

3 

35.1 

1888 

613,376 

73 

11.9 

1898 

8,642 

9 

104.1 

1889 

624,105 

70 

11.2 

1899 

8,737 
8,832 

8 
10 

91.6 
113.2 

1890 

634,930 

80 

12.6 

1900 

1886-1890 

3,079,265 

349 

11.3 

1896-1900 

43,210 

36 

83.3 

iOOUAtJCV 

1891 

636,559 

91 

14.3 

1901 

8,929 

6 

67.2 

1892 

643,407 

88 

13.7 

1902 

9,024 

5 

55.4 

1893 

651,615 

96 

14.7 

1903 

9,124 

8 

87.7 

1894 

661,046 

102 

15.4 

1904 

9,224 
9,324 

8 

7 

86.7 
75.1 

1895 

670,383 

115 

17.2 

1905 

18Q1-18Q5 

3,263,010 

492 

15.1 

1901-1905 

45,625 

34 

74.5 

j.O(7x    xijiytj 

1896 

679,198 

113 

16.6 

1906 

9,424 

7 

74.3 

1897 

688,534 

97 

14.1 

1907 

9,524 

4 

42.0 

1898 

698,133 

109 

15.6 

1908 

9,624 

7 

72.7 

1899 

708,106 

129 

18.2 

1909 

9,724 
9,824 

9 
4 

92.6 
40.7 

1900 

718,783 

124 

17.3 

1910 

18Q6-1900 

3,492,754 

572 

16.4 

1906-1910 

48,120 

31 

64.4 

±Oi7\M     ±i7\J\I 

1901 

729,093 

118 

16.2 

1911 

9,924 

2 

20.2 

1902 

739,970 

109 

14.7 

1912 

10,109 

6 

59.4 

1903 

752,630 

125 

16.6 

1913 

10,293 

7 

68.0 

1904 
1905 

764,081 
773,517 

128 
153 

16.8 
19.8 

Source:    Bermuda,  Reports  of  the  Regis- 
trar-General, 1891-1913. 


1901-1905 

3,759,291 

633 

16.8 

1906 

781,779 

141 

18.0 

1907 

791,373 

126 

15.9 

1908 

796,862 

136 

17.1 

1909 

803,867 

149 

18.5 

1910 

•    814,987 

169 
721 

20.1 

1906-1910 

3,988,868 

18.1 

1911 

826,078 

142 

17.2 

1912 

888,575 

153 

18.2 

1913 

851,072 

157 

18.4 

Source:      Jamaica,    Annual  Reports  of 
the  Registrar-General. 


748 


APPENDIX  G 


Table  313 

Table  314 

Mortality  from  Cancer  in 

Jamaica 

Mortality  from  Cancer  in  Jamaica 

Males,  1881 

-1913 

Deaths 

Rate  per 

Females,  1881-1913 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1881 

277,857 

21 

7.6 

1881 

302,947 

36 

11.9 

1882 

281,643 

17 

6.0 

1882 

307,075 

26 

8.5 

1883 

284,181 

21 

7.4 

1883 

309,842 

44 

14.2 

1884 

283,126 

28 

9.9 

1884 

308,693 

38 

12.3 

1885 

285,310 

21 
108 

7.4 
7.6 

1885 
1881-1885 

311,073 

43 

187 

13.8 

1881-1885 

1,412,117 

1,539.630 

12.1 

1886 

288,645 

24 

8.3 

1886 

314,709 

41 

13.0 

1887 

288,714 

17 

5.9 

1887 

314,786 

44 

14.0 

1888 

293,439 

26 

8.9 

1888 

319,937 

47 

14.7 

1889 

298,572 

22 

7.4 

1889 

325,533 

48 

14.7 

1890 

89 

7.6 

1890 
1886-1889 

180 

1886-1889 

1,169,370 

1,274,965 

14.1 

1891 

304,530 

26 

8.5 

1891 

332,029 

65 

19.6 

1892 

307,806 

27 

8.8 

1892 

335,601 

61 

18.2 

1893 

311,733 

33 

10.6 

1893 

339,882 

63 

18.5 

1894 

316,244 

32 

10.1 

1894 

344,802 

70 

20.3 

1895 

320,711 

40 
158 

12.5 
10.1 

1895 
1891-1895 

349,672 

75 
334 

21.4 

1891-1895 

1,561,024 

1,701,986 

19.6 

1896 

324,928 

42 

12.9 

1896 

354,270 

71 

20.0 

1897 

329,395 

37 

11.2 

1897 

359,139 

60 

16.7 

1898 

333,987 

45 

13.5 

1898 

364,146 

64 

17.6 

1899 

338,758 

33 

9.7 

1899 

369,348 

96 

26.0 

1900 

343,866 

50 
207 

14.5 
12.4 

1900 
1896-1900 

374,917 

74 
365 

19.7 

1896-1900 

1,670,934 

1,821,820 

20.0 

1901 

348,798 

31 

8.9 

1901 

380,295 

87 

22.9 

1902 

354,002 

35 

9.9 

1902 

385,968 

74 

19.2 

1903 

359,983 

37 

10.3 

1903 

392,647 

88 

22.4 

1904 

365,460 

46 

12.6 

1904 

398,621 

82 

20.6 

1905 

369,896 

47 
196 

12.7 
10.9 

1905 
1901-1905 

403,621 

106 
437 

26.3 

1901-1905 

1,798,139 

1,961,152 

22.3 

1906 

373,847 

48 

12.8 

1906 

407,932 

93 

22.8 

1907 

378,435 

40 

10.6 

1907 

412,938 

86 

20.8 

1908 

380,980 

39 

10.2 

1908 

415,882 

97 

23.3 

1909 

384,329 

45 

11.7 

1909 

419,538 

104 

24.8 

1910 

389,645 

55 

227 

14.1 
11.9 

1910 
1906-1910 

425,342 

114 
494 

26.8 

1906-1910 

1,907,236 

2,081,632 

23.7 

1911 

394,865 

5Q 

14.2 

1911 

431,213 

86 

19.9 

1912 

400,839 

55 

13.7 

1912 

437,736 

98 

22.4 

1913 

406,813 

58 

14.3 

1913 

444,259 

99 

22.3 

Source: 

Jamaica,  Ann 

ual  Reports  of  the 

Source: 

Jamaica,  Annual  Reports  of  the 

Registrar-General. 

Registrar-General. 

749 


APPENDIX  G 


Table 

315 

Table  316 

Mortality  from  Cancer  in  the 

Mortality  from  Cancer  in 

Trinidad 

Windward  and  Leeward  Islands 

1890-1913 

British  West  Indies 
1901-1912 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Deaths 

Rate  per 

Cancer 

Population 

Year 

Population 

from 
Cancer 

100,000 
Population 

1890 

196,510 

25 

12.7 

1901 

110,214 

.26 

23.6 

1891 

201,200 

7 

3.5 

1902 

110,350 

25 

22.7 

1892 

206,220 

25 

12.1 

1903 

110,448 

23 

20.8 

1893 

211,301 

30 

14.2 

1901, 

200,420 

49 

24.4 

1894 

216,508 

38 

17.6 

1905 

237,254 

83 

206 

35.0 
26.8 

1895 
1891-1895 

221,842 

20 
120 

9.0 

1901-1905 

768,686 

1,057,071 

11.4 

1906 

237,896 

70 

29.4 

1896 

227,309 

23 

10.1 

1907 

238,344 

57 

23.9 

1897 

232,909 

23 

9.9 

1908 

238,865 

64 

26.8 

1898 

238,648 

18 

7.5 

1909 

239,239 

61 

25.0 

1899 

264,630* 

33 

12.5 

1910 

239,930 

54 
306 

22.5 
25.6 

1900 
1896-1900 

269,893 

42 
139 

15.6 

1906-191C 

1,194,274 

1,233,389 

11.3 

1911 

240,586 

64 

26.6 

1901 

275,261 

32 

11.6 

1912 

237,041 

80 

33.7 

1902 

282,125 

47 

16.7 

1903 

287,737 

47 

16.3 

Source : 

The    Registrar-General's     Re- 

1904 

293,460 

38 

12.9 

ports    of 

the     several     above-mentioned 
Includes  St.  Kitts-Ne^^s,  1901- 

1905 
1901-1905 

299,296 

79 
243 

26.4 

islcincls. 
Note: 

1,437,879 

16.9 

1912,  Grenada,  1901-1912,  St.  Lucia,  1904- 

1912,  St. 

Vincent,  1904-1912,  Antigua  and 

1906 

305,249 

68 

22.3 

Barbuda, 

1905-1912. 

1907 

311,321 

81 

26.0 

1908 

317,513 

50 

15.7 

1909 

323,828 

61 

18.8 

1910 
1906-1910 

330,270 

71 
331 

21.5 

1,588,181 

20.8 

1911 

336,839 

88 

26.1 

1912 

343,408 

101 

29.4 

1913 

348,958 

120 

34.4 

Source: 

Annual  Reports  of 

the  Regis- 

trar-General     on     the 

Vital 

Statistics, 

Trinidad. 

Tobago  is 

not  included  previously  to  1899. 

750 


APPENDIX  G 

Table  317 

Mortality  from  Cancer  in  the  Hospitals  of  Barbados 

1899-1903 


Deaths  Deaths 

from  All  from  Cancer 

Year                                                                                                   Causes  Cancer  Per  Cent. 

1899 860  24  2.8 

1900 782  27  3.5 

1901 985  29  2.9 

1902 857  19  2.2 

1903 712  21  2.9 

1899-1903 4,196  120  2.9 

Source:     Correspondence  relating  to  the  Cancer  Research  Scheme,  London,  1906. 


Table  318 

Table  319 

Mortality  from  Cancer  in  St.Thomas 

Mortality  from  Cancer  in 

British 

Danish  West  Indies 

Honduras, 

1894- 

■1913 

1901- 

1914 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

Deaths 
from 

Rate  per 
100,000 

Cancer 

Population 

Cancer 

Population 

1894 

33,272 

3 

9.0 

1901 

11,012 

6 

54.5 

1895 

33,873 

3 

8.9 

1902 

10,978 

6 

54.7 

1903 

10,944 

6 

54.8 

1896 

34,474 

6 

17.4 

1904 

10,910 

18 

165.0 

1897 

35,075 

1 

2.9 

1905 

10,876 

7 

64.4 

1898 
1899 

35,676 
36,277 

6 
4 

16.8 
11.0 

1901-1905 

54,720 
10,843 

43 

1 

78.6 
9.2 

1900 
1896-1900 

36,878 

7 
24 

19.0 

1906 

178,380 

13.5 

1907 

10,810 

12 

111.0 

1908 

10,777 

4 

37.1 

1901 

37,479 

10 

26.7 

1909 

10,744 

13 

121.0 

1902 

37,776 

8 

21.2 

1910 

10,711 

9 

84.0 

1903 
1904 

38,074 
38,372 

3 

8 

7.9 
20.8 

1906-1910 

53,885 
10,678 

39 
15 

72.4 
140.5 

1905 
1901-1905 

38,670 

7 
36 

18.1 

1911 

190,371 

18.9 

1912 

10,646 

9 

84.5 

1913 

10,614 

17 

160.2 

1906 

38,968 

6 

15.4 

1914 

10,572 

5 

47.3 

1907 
1908 

39,266 
39,564 

7 
8 

17.8 
20.2 

Source: 

Sanitary 

Reports 

for     St. 

1909 

39,862 

4 

10.0 

Thomas,  D 

W.I. 

1910 
1906-19.10 

40,160 

4 
29 

10.0 

197,820 

14.7 

1911 

40,458 

8 

19.8 

1912 

40,814 

11 

27.0 

1913 

41,170 

5 

12.1 

Source: 

Letter  from  the 

Acting  Regis- 

trar-General  of  British  Honduras 

49 


751 


APPENDIX  G 

Table  320 

Mortality  from  Cancer  in  British  Guiana 

1896-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1896 

287,528 

60 

20.9 

1906 

299,573 

72 

24.0 

1897 

289,368 

57 

19.7 

1907 

299,791 

55 

18.3 

1898 

291,208 

48 

16.5 

1908 

297,997 

75 

25.2 

1899 

293,048 

49 

16.7 

1909 

297,905 

49 

16.4 

1900 

294,888 

70 

284 

23.7 
19.5 

1910 
1906-1910 

297,097 

38 
289 

12.8 

1896-1900 

1,456,040 

1,492,363 

19.4 

1901 

296,728 

78 

26.3 

1911 

295,879 

49 

16.6 

1902 

297,306 

54 

18.2 

1912 

299,044 

60 

20.1 

1903 

297,884 

75 

25.2 

1913 

301,596 

88 

29.2 

1904 

297,398 

59 

19.8 

1905 

297,416 

59 

19.8 

Source: 

British  Guiana,  Report  of  the 

Registrar-General . 

1901-1905 

1,486,732 

325 

21.9 

Table  321 

Mortality  from  Cancer  in  British  Guiana,  Males 

1896-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1896 

153,080 

21 

13.7 

1906 

157,554 

31 

19.7 

1897 

154,060 

30 

19.5 

1907 

157,158 

14 

8.9 

1898 

155,039 

20 

12.9 

1908 

155,746 

33 

21.2 

1899 

156,019 

18 

11.5 

1909 

155,380 

19 

12.2 

1900 

156,998 

20 
109 

12.7 
14.1 

1910 
1906-1910 

154,616 

21 
118 

13.6 

1896-1900 

775,196 

780,454 

15.1 

1901 

157,978 

26 

16.5 

1911 

153,602 

21 

13.7 

1902 

158,273 

21 

13.3 

1912 

155,154 

32 

20.6 

1903 

158,041 

38 

24.0 

1913 

156,563 

31 

19.8 

1904 

157,288 

18 

11.4 

1905 

156,846 

13 

8.3 

Source: 

British  Guiana,  Report  of  the 

Registrar- 

General. 

1901-1905 

788,426 

116 

14.7 

752 


APPENDIX  G 

Table  322 

Mortality  from  Cancer  in  British  Guiana,  Females 

1896-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1896 

134,448 

39 

29.0 

1906 

142,019 

41 

28.9 

1897 

135,308 

27 

20.0 

1907 

142,633 

41 

28.7 

1898 

136,169 

28 

20.6 

1908 

142,251 

42 

29.5 

1899 

137,029 

31 

22.6 

1909 

142,525 

30 

21.0 

1900 

137,890 

50 

175 

36.3 
25.7 

1910 
1906-1910 

142,481 

17 

171 

11.9 

1896-1900 

680,844 

711,909 

24.0 

1901 

138,750 

52 

37.5 

1911 

142,277 

28 

19.7 

1902 

139,033 

33 

23.7 

1912 

143,890 

28 

19.5 

1903 

139,843 

37 

26.5 

1913 

145,033 

57 

39.3 

1904 

140,110 

41 

29.3 

1905 

140,570 

46 

32.7 

Source : 

British  Guiana,  Report  of  the 

Registrar-General. 

1901-1905 

698,306 

209 

29.9 

Table  323 
Mortality  from  Cancer  in  the  City  of  Paramaribo,  Dutch  Guiana 

1903-1912 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1903 

33,100 

28 

84.6 

1904 

33,535 

31 

92.4 

1905 

34,085 

30 

88.0 

1906 

34,870 

27 

77.4 

1907 

34,962 

36 

103.0 

1908 

34,795 

54 

155.2 

1909 

35,082 

34 

96.9 

1910 

35,000 

32 
183 

91.4 

06-1910 

174,709 

104.7 

1911 

34,898 

28 

80.2 

1912 

35,000 

19 

54.3 

Source:     Original  data  furnished  by  the 
Secretary  to  the  Governor  of  Suriname. 


753 


APPENDIX  G 

Table  324 
Mortality  from  Cancer  in  the  City  of  Paramaribo,  Dutch  Guiana,  by  Sex 

1903-1912 


MALES 

FEMALES 

Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1903 

15,100 

9 

59.6 

1903 

18,000 

19 

105.6 

1904 

15,392 

7 

45.5 

1904 

18,143 

24 

132.3 

1905 

15,726 

8 

50.9 

1905 

18,359 

22 

119.8 

1906 

15,973 

10 

62.6 

1906 

18,897 

17 

90.0 

1907 

16,168 

17 

105.1 

1907 

18,794 

19 

101.1 

1908 

16,162 

24 

148.5 

1908 

18,633 

30 

161.0 

1909 

16,176 

11 

68.0 

1909 

18,906 

23 

121.7 

1910 

16,200 

10 

72 

61.7 

89.2 

1910 
1906-1910 

18,800 

22 
111 

117.0 

1906-1910 

80,679 

94,030 

118.0 

1911 

16,259 

12 

73.8 

1911 

18,639 

16 

85.8 

1912 

16,300 

7 

42.9 

1912 

18,700 

12 

64.2 

Source: 

Original  data  furnished  by  the 

Secretary  to  the  Governor  of  Sirriname. 

Table  325 

Mortality  from  Cancer  in  Cuba 

1901-1913 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Populatioi 

1901 
1902 
1903 
1904 
1905 

1,691,843 
1,751,366 
1,810,889 
1,870,412 
1,929,935 

503 
539 
601 
661 
746 

29.7 
30.8 
33.2 
35.3 
38.7 

1901-1905 

9,054,445 

3,050 

33.7 

1906 
1907 
1908 
1909 
1910 

1,989,458 
2,048,980 
2,082,691 
2,116,402 
2,150,112 

808 
813 
901 
981 
991 

40.6 
39.7 
43.3 

46.4 
46.1 

1906-1910  10,387,643 

4,494 

43.3 

1911 
1912 
1913 

2,229,257 
2,313,615 
2,391,134 

977 
1,005 
1,145 

43.8 
43.4 
47.9 

Source:  Informe  bi-anual  Sanitario  y 
Demografico  de  la  Republica  de  Cuba, 
1902-1905. 

Sanidad  y  Beneficencia.  Boletin  oficial 
de  la  Secretaria,  1906-1912. 


754 


APPENDIX  G 

Table  326 

Mortality  from  Cancer  in  Cuba,  by  Sex 

1902-1913 


MALES 

FEMALES 

Deaths 

Rale  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1902 

912,585 

245 

26.8 

1902 

838,781 

294 

35.1 

1903 

945,045 

293 

31.0 

1903 

865,844 

308 

35.6 

1904 

977,505 

310 

31.7 

1904 

892,907 

351 

39.3 

1905 

1,009,965 

358 

35.4 
31.4 

1905 
1902-1905 

919,970 

388 

42.2 

1902-1905 

3,845,100 

1,206 

3,517,502 

1,341 

38.1 

1906 

1,042,425 

360 

34.5 

1906 

947,033 

448 

47.3 

1907 

1,074,882 

393 

36.6 

1907 

974,098 

420 

43.1 

1908 

1,093,880 

453 

41.4 

1908 

988,811 

448 

45.3 

1909 

1,112,878 

501 

45.0 

1909 

1,003,524 

480 

47.8 

1910 

1,131,876 

516 

45.6 
40.7 

1910 
1906-1910 

1,018,236 

475 

46.6 

1906-1910 

5,455,941 

2,223 

4,931,702 

2,271 

46.0 

1911 

1,175,041 

500 

42.6 

1911 

1,054,216 

477 

45.2 

1912 

1,221,126 

516 

42.3 

1912 

1,092,489 

489 

44.8 

1913 

1,262,041 

605 

47.9 

1913 

1,129,093 

540 

47.8 

Source: 

Informe    bi-anual   Sanitario   v 

Demografico   de   la   Republica 

de   Cuba, 

1902-1905. 

Sanidad 

y  Beneficencia.     Boletin  oficial 

de  la  Secretaria,  1906-1913. 

Table  327 
Mortality  from  Cancer  in  Cuba,  by  Organs  and  Parts,  according  to  Sex 

1908-1912 


MALES 


Organ  or  Part 

Buccal  cavity 

Stomach  and  liver 

Peritoneum,  intestines,  rectum. 

Female  generative  organs 

Breast 

Skin 

Other  or  not  specified  organs. . 


Deaths 

from 

Cancer 

455 

870 
143 

7 
140 

871 


All  organs 2,486 


Rate  per 

100,000 

Population 

7.9 
15.2 

2.5 

o.i 

2.4 
15.2 

43.3 


FEMALES 

Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

138 

2.7 

513 

9.9 

160 

3.1 

973 

18.9 

232 

4.5 

75 

1.5 

278 

5.4 

2,369 


45.9 


Source:     Sanidad  y  Beneficencia.     Boletin  oficial  de  la  Secretaria.     Habana. 


755 


APPENDIX  G 


Table  328 
Mortality  from  Cancer  in  Cuba,  by  Organs  and  Parts,  according  to  Race 

1908-1912 


WHITE 


Organ  or  Part 


Deaths 

from 
Cancer 


Buccal  cavity 485 

Stomach  and  liver 1,014 


Peritoneum,  intestines,  rectum . 

Breast 

Female  generative  organs 

Skin 

Other  or  not  specified  organs . . 


232 

148 
626 
171 
956 


Rate  per 

100,000 

Population 

6.4 
13.5 

3.1 

2.0 

8.3 

23 
12.7 


COLORED 

Deaths 

Rate  per 

from 

100.000 

Cancer 

Population 

108 

3.4 

369 

11.5 

71 

2.2 

91 

2.8 

347 

10.8 

44 

1.4 

193 

6.0 

All  organs 3,632  48.2  1,223  38.0 

Source:     Sanidad  y  Beneficencia.     Boletin  oficial  de  la  Secretaria.     Habana. 


Table  329 

Mortality  from  Cancer  in  Havana,  Cuba 

1899-1912 


Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Cancer 

Population 

1899 

242,055 

142 

58.7 

1900 

249,613 

140 

56.1 

1901 

257,172 

171 

66.5 

1902 

264,731 

176 

66.5 

1903 

272,290 

213 

78.2 

1904 

279,849 

210 

75.0 

1905 

287,408 

232 

80.7 

01-1905 

1,361,450 

1,002 

73.6 

1906 

294,967 

268 

90.9 

1907 

302,526 

269 

88.9 

1908 

310,616 

318 

102.4 

1909 

318,706 

344 

107.9 

1910 

326,796 

338 

103.4 

06-1910 

1,553,611 

1,537 

98.9 

1911 

334,886 

340 

101.5 

1912 

353,509 

329 

93.1 

Source:  Informe  bi-anual  Sanitario  y 
Demografico  de  la  RepubHca  de  Cuba, 
1902-1905. 

Sanidad  y  Beneficencia.  Boletin  oficial 
de  la  Secretaria,  1906-1912. 


756 


APPENDIX  G 

Table  330 

Mortality  from  Cancer  in  Porto  Rico 

1910-1913 


■y                                                                                                                                                    Deaths  Rate  per 

(Endfilg                                                                                           Population                         from  100,000 

June  30)                                                                                                                                           Cancer  Population 

1910 1,113,406                     207  18.6 

1911 1,129,198                       195  17.3 

1912 1,144,990                     223  19.5 

1913 1,160,782                      285  24.6 

1910-1913 4,548,376                     910  20.0 

Source:     Informe  Anual  del  Director  de  Sanidad  al  Hon.  Gobernador  de  Puerto  Rico. 

Table  331 

Mortality  from  Cancer  in  Porto  Rico,  by  Organs  and  Parts 

July  1,  1910,  to  June  30,  1913 

Deaths  Rate  per 

Organ  or  Part                                                                                               from  100,000 

Cancer  Population 

Buccal  cavity 37  1.1 

Stomach  and  liver 174  5.1 

Peritoneum,  intestines  and  rectum 56  1.6 

Generative  organs 229  6.7 

Breast 20  0.6 

Skin : 25  0.7 

Other  or  not  specified  organs 162  4.7 

All  organs 703  20.5 

Source:    Informe  Anual  del  Director  de  Sanidad  al  Hon.  Gobernador  de  Puerto  Rico. 


757 


APPENDIX  G 

Table  332 

Mortality  from  Cancer  in  the  City  of  Mexico,  by  Sex 

1905-1913 


TOTAL 

3MALES 

Year 
1905 

Population 
419,981 

Deaths 
from 
Cancer 

249 

Rate  per 

100,000 

Population 

59.3 

Year 
1905 

Population 
196,209 

Deaths 
from 
Cancer 

61 

Rate  per 

100,000 

Population 

31.1 

1906 
1907 
1908 
1909 
1910 

430,198 
440,415 
450,632 
460,849 
471,066 

251 
243 
252 
221 
229 

58.3 
55.2 
55.9 

48.0 
48.6 

53.1 

1906 
1907 
1908 
1909 
1910 

1906-1910 

200,722 
205,235 
209,748 
214,261 

218,774 

61 

77 
77 
61 
51 

30.4 
37.5 
36.7 

28.5 
23.3 

1906-1910 

2,253,160 

1,196 

1,048,740 

327 

31.2 

1911 
1912 
1913 

481,283 
491,500 
501,717 

208 
255 
242 

43.2 
51.9 

48.2 

1911 
1912 
1913 

223,287 
227,800 
232,313 

49 
61 
55 

21.9 
26.8 
23.7 

FEMALES 

Year 
1905 

Population 

223,772 

Deaths 
from 
Cancer 

188 

Rate  per 

100,000 

Population 

84.0 

1906 
1907 
1908 
1909 
1910 

229,476 
235,180 
240,884 
246,588 
252,292 

190 

166 
175 
160 

178 

82.8 
70.6 
72.6 
64.9 
70.6 

1906-1910 

1.204,420 

869 

72.2 

1911 
1912 
1913 

257,996 
263,700 
269,404 

159 
194 

187 

61.6 
73.6 
69.4 

Source:  Boletin  del  Consejo  Superior 
de  Salubridad.  Publicacion  Mensual. 
Mexico,  1905-1913. 


758 


APPENDIX  G 

Table  333 

Mortality  from  Cancer  in  the  City  of  Mexico,  by  Organs  and  Parts 

according  to  Sex,  1908-1912 


Organ  or  Part 

Buccal  cavity 

Stomach  and  liver 

Peritoneum,  intestines,  rectum . 

Female  generative  organs 

Breast 

Skin 

Other  or  not  specified  organs .  . 


Deaths 

from 

Cancer 

30 
80 
26 


20 
143 


299 


MALES 


Rate  per 

100,000 

Population 

2.7 
7.3 
2.4 


1.8 
13.1 


27.3 


FEMALES 

Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

17 

1.3 

119 

9.4 

50 

4.0 

458 

36.3 

44 

3.5 

10 

0.8 

1G8 

13.3 

866 


68.6 


All  organs 

Source:     Boletin  del  Consejo  Superior  de  Salubridad.     Publicacion  Mensual.     Mex- 
ico, 1908-1912. 


Table  334 

Table  335 

Mortality  from  Cancer  in 

the  Re- 

Mortality  from  Cancer  in  Nicaragua 

public  of  Costa  Rica 

1908-1911 

1901-1912 

M.7\Jt.      i.7  i.*i 

Deaths 
Population            from 

Rate  per 
100,000 

Deaths 

Rate  per 

Year 

Year 

Population            from 

100,000 

Cancer 

Population 

Cancer 

Population 

1908 

530,000             80 

15.1 

1901 

307,499 

68 

22.1 

1909 

540,000              62 

11.5 

1902 

312,819 

84 

26.9 

1910 

550,000              42 

7.6 

1903 

316,738 

102 

32.2 

1911 

560,000              47 

8.4 

1904 

322,618 

111 

34.4 

1905 

331,340 

119 

35.9 
30.4 

1908-1911 
Source: 

2,180,000            231 
Boletin  de  Estadis 

10.6 

1901-1905 

1,591,014 

484 

tica  de  la 

RepubHca 

de  Nicaragua. 

1906 

334,297 

122 

36.5 

1907 

341,590 

133 

38.9 

1908 

351,176 

154 

43.9 

1909 

361,779 

142 

39.3 

1910 

368,780 

140 

38.0 
39.3 

1906-1910 

1,757,622 

691 

1911 

379,533 

144 

37.9 

1912 

388,266 

171 

44.0 

Source: 

Resumenes  Estadisticos.    Anos 

1883-1910,  San  Jose,  1912. 

Republica  de  Costa  Rica 

Anuario  Esta- 

distico,  1911-1912. 

759 


APPENDIX  G 

Table  336 
Mortality  from  Cancer  in  the  City  of  San  Salvador,  by  Organs  and  Parts 

1912 


Deaths 
Organ  or  Part  from 

Cancer 

Tongue 1 

Throat 3 

Stomach 11 

Uterus 1 

Not  specified 17 

Sarcoma 1 

All  organs 34 

Source:     Memoria  de  la  Municipalidad  de  San  Salvador,  1912. 


Rate  per 

100,000 

Population 

1.7 

5.0 
18.5 

1.7 
28.6 

1.7 

57.1 


Table  337 
Mortality  from  Cancer  in  the  Re- 
public of  Venezuela,  1905-1912 


Year 


Population 


1905         2,608,033 


Deaths  Rate  per 

from  100,000 

Cancer  Population 

407  15.6 


1906 
1907 
1908 
1909 
1910 


2,627,434 
2,646,835 
2,666,236 
2,685,637 
2,705,038 


429 
396 
386 
346 
403 


1906-1910  13,331,180         1.960 


1911 
1912 

Source: 
zuela. 


2,724,439 
2,743,841 


437 
430 


16.3 
15.0 
14.5 
12.9 
14.9 

14.7 

16.0 
15.7 


Anuario  Estadistico  de  Vene- 


Table  338 

Mortality  from  Cancer  in  the  City  of 

Bogota,  Colombia,  1912-1913 


Year 

1912 
1913 


Population 

121,257 
121,729 


Deaths  Rate  per 

from  100,000 

Cancer  Population 

112  92.4 

106  87.1 


1912-1913        242,986  218  89.7 

Source:     Registro  Municipal  de  Higiene, 


Table  339 

Mortality  from  Cancer  in  Guayaquil 

Ecuador,  1910-1912 


Year  Population 


1910* 

1911 

1912 


40,000 
80,000 
80,000 


Deaths  Rate  per 

from  100,000 

Cancer  Population 

23  57.5 

57  71.3 

42  52.5 


1910-1912        200,000 


122 


61.0 


Source:  Original  data  furnished  by  Mr. 
Charles  S.  Hartman,  envoy  extraordinary 
and  minister  plenipotentiary,  Quito,  Ecua- 
dor. 

*January  to  June. 

Table  340 

Mortality  from  Cancer  in  the  City  of 

La  Paz,  Bolivia,  1900-1909 


Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Cancer 

Population 

1900 

59,633 

i 

3.4 

1901 

59,832 

13 

21.7 

1902 

60,031 

18 

30.0 

1903 

62,720 

12 

19.1 

1904 

65,409 

10 

15.3 

1905 

68,098 

16 
69 

23.5 

1901-1905 

316,090 

21.8 

1906 

70,787 

18 

25.4 

1907 

73,476 

2 

2.7 

1908 

76,166 

6 

7.9 

1909 

78.856 

4 

5.1 

Source:      Censo  Municipal  de  la  Ciudad 
de  La  Paz  15  de  Junio  de  1909. 


760 


APPENDIX  G 

Table  341 

Mortality  from  Cancer  in  the  City  of  Lima,  Peru,  by  Organs  and  Parts 
according  to  Sex,  1904 


Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

4 

3.1 

53 

40.8 

9 

6.9 

35 

26.9 

2 

1.5 

1 

.      0.8 

31 

23.8 

Organ  or  Part 

Buccal  cavity 

Stomach  and  liver 

Peritoneum,  intestines,  rectum. 

Female  generative  organs 

Breast 

Skin 

Other  or  not  specified  organs. . 

All  organs 135  103.8  50  85 

Source:     Datos  Demograficos  de  la  Ciudad  de  Lima  en  el  Ano  de  1904. 


Deaths  fbo&i 

Canceb 

Males 

Females 

2 

2 

27 

26 

2 

7 

35 

2 

1 

18 

13 

Table  342 

Mortality  from  Cancer  in  the  City  of  Trujillo 

1903-1913 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1903 

8,000 

6 

75.0 

1904 

8,000 

8 

100.0 

1905 

8,000 

9 

23 

112.5 

1903-1905 

24,000 

95.8 

1906 

8,000 

7 

87.5 

1907 

8,000 

13 

62.5 

1908 

8,000 

16 

200.0 

1909 

8,000 

9 

112.5 

1910 

8,000 

12 
67 

150.0 

1906-1910 

40,000 

142.5 

1911 

8,000 

18 

225.0 

1912 

8,000 

14 

175.0 

1913 

8,000 

14 

175.0 

Source:  Original  data  furnished  by  the 
Director  of  Registro  Civil  y  Estadistica, 
Trujillo,  Peru. 


761 


APPENDIX  G 

Table  343 

Mortality  from  Cancer  in  the  City  of  Rio  de  Janeiro,  Brazil 

1891-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1891 

440,118 

151 

34.3 

1906 

625,756 

291 

46.5 

1892 

450,636 

153 

34.0 

1907 

636,018 

271 

42.6 

1893 

461,411 

149 

32.3 

1908 

637,089 

290 

45.5 

1894 

472,454 

152 

32.2 

1909 

649,362 

285 

43.9 

1895 

483,773 

164 

33.9 
33.3 

1910 
1906-1910 

669,781 

295 

44.0 

1891-1895 

2,308,392 

769 

3,218,006 

1,432 

44.5 

1896 

405,380 

167 

33.7 

1911 

690,200 

282 

40.9 

1897 

507,286 

168 

33.1 

1912 

710,600 

275 

38.7 

1898 

519,503 

189 

36.4 

1913 

731,000 

304 

41.6 

1899 

532,042 

179 

33.6 

1900 

544,917 

199 

36.5 

Source: 

Annuario 

Estatistico  Demo- 

rr^          1             Cr.Tii4-n-»,^n        "O  i  ^      A^       T  n  n  ^i 

1896-1900 

2,599,128 

902 

34.7 

ffr£ipiio-o3.r                                           "'^ 

IXUaXlCky     A.\jl\J      VJ 

ns    uaL±s:^XL\j 

1901 

558,140 

189 

33.9 

1902 

571,728 

197 

34.5 

1903 

585,695 

235 

40.1 

1904 

600,057 

240 

40.0 

1905 

614,831 

237 

38.5 
37.5 

1901-1905 

2,930,451 

1,098 

Table  344 
Mortality  from  Cancer  in  the  Federal  District  of  Rio  de  Janeiro 

1903-1913 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1903 
1904 
1905 

749,180 

771,276 
794,266 

254 
260 
257 

33.9 
33.7 
32.4 

1906 
1907 
1908 
1909 
1910 

811,443 
824,040 
825,812 
842,822 
870,475 

318 
293 
313 
306 
334 

39.2 
35.6 
37.9 
36.3 
38.4 

06-1910 

4,174,592 

1,564 

37.5 

1911 
1912 
1913 

912,169 
965,766 
980,094 

328 
312 
356 

36.0 
32.3 
36.3 

Source:         Annuario  Estatistico  Demo- 
grapho-Sanitaria,  Rio  de  Janeiro. 


762 


APPENDIX  G 

Table  345 

Mortality  from  Cancer  in  the  Federal  District  of  Rio  de  Janeiro 

by  Organs  and  Parts,  Males,  1906-1910 


Organ  or  Part  1906  1907  1908  1909  1910  1908-10 

Buccal  cavity 29  13  17  20  14  93 

Stomach 34  36  42  37  36  185 

Liver 6  6  17  13  11  63 

Peritoneum,  intestines,  rectum . .  6  5  11  9  10  41 

Skin 9  16  9  9  5  48 

Other  or  not  specified  organs ...  50  69  66  65  75  325 

All  organs 134  145  162  153  15  745 

Source:     Annuario  Estatistico  Demographo-Sanitaria,  Rio  de  Janeiro. 


Per  Cent, 
of  All 
Organs 

12.5 

24.8 

7.1 

5.5 

6.5 

43.6 


100.0 


Table  346 

Mortality  from  Cancer  in  the  Federal  District  of  Rio  de  Janeiro 

by  Organs  and  Parts,  Females,  1906-1910 


Organ  or  Part  1906  1907  1908  1909  1910 

Buccal  cavity 6  4  2  2  7 

Stomach 12  9  11  9  12 

Liver 6  1  4  4  4 

Peritoneuna,  intestines,  rectum .  .  5  8  5  5  9 

Breast 13  11  9  15  16 

Generative  organs 66  50  58  52  50 

Skin 4  2  7  3  1 

Other  organs 72  63  55  63  84 

All  organs 184  148  151  153  183 

Source:     Annuario  Estatistico  Demographo-Sanitaria,  Rio  de  Janeiro. 


Per  Cent. 

906-10 

of  All 

Organs 

21 

2.6 

53 

6.5 

19 

2.3 

32 

3.9 

64 

7.8 

276 

33.7 

17 

2.1 

337 

41.1 

819 


100.0 


763 


APPENDIX  G 

Table  347 

Mortality  from  Cancer  in  the  City  of  Bahia 

1897-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1897 

196,394 

32 

16.3 

1906 

251,500 

59 

23.5 

1898 

199,534 

24 

12.0 

1907 

259,200 

54 

20.8 

1899 

202,673 

38 

18.7 

1908 

266,900 

72 

27.0 

1900 

205,813 

32 

15.5 

1909 

274,600 

71 

25.9 

1910 

282,300 

68 

20.5 

1897-1900 

804,414 

126 

15.7 

1906-1910 

1,334,500 

314 

23.5 

1901 

213,400 

47 

22.0 

1902 

221,000 

58 

26.2 

1911 

290,000 

68 

23.4 

1903 

228,600 

72 

31.5 

1912 

300,000 

59 

19.7 

1904 

236,200 

69 

29.2 

1905 

243,800 

53 

21.7 

Source: 

Annuario  de  Estatistica  Demo- 

grapho-Sanitaria  da  Cidade  do 

Salvador 

1901-1905 

1,143.000 

299 

26.2 

(Bahia),  1900-1908. 

Boletin 

Mensal    de 

Estatistica   Demo- 

grapho-Sanitaria  da  Cidade  do 

Salvador, 

1909-1912. 

Table  348 

Mortality  from  Cancer  in  the  City  of  Bahia,  Males 

1900-1911 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1900 

97,642 

6 

6.1 

1906 

119,300 

13 

10.9 

1907 

123,000 

15 

12.2 

1901 

101,200 

12 

11.9 

1908 

126,700 

19 

15.0 

1902 

104,800 

13- 

12.4 

1909 

130,400 

22 

16.9 

1903 

108,400 

18 

16.6 

1910 

134,100 

21 

15.7 

1904 

112,000 

21 

18.8 

1905 

115,600 

17 
81 

14.7 
14.9 

1906-1910 
1911 

633,500 
137,800 

90 
21 

14.2 

1901-1905 

542,000 

15.2 

Source: 

Annuario  de  Estatistica  Demo- 

grapho-Sanitaria  da  Cidade  do 

Salvador 

(Bahia),  1900-1908. 

Boletin 

Mensal   de 

Estatistica   Demo- 

grapho-Sanitaria  da  Cidade  do  Salvador, 

1909-1911. 

764 


APPENDIX  G 

Table  349 

Mortality  from  Cancer  in  the  City  of  Bahia,  Females 

1900-1911 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1900 

108.171 

26 

24.0 

1906 

132,200 

46 

34.8 

1907 

136,200 

39 

28.6 

1901 

112.200 

35 

31.2 

1908 

140,200 

53 

37.8 

1902 

116,200 

45 

38.7 

1909 

144,200 

49 

34.0 

1903 

120,200 

54 

44.9 

1910 

148,200 

37 

25.0 

1904 

124,200 

48 

38.6 

1905 

128,200 

36 
218 

28.1 
36.3 

1906-1910 
1911 

701,000 
152,200 

224 

47 

32.0 

1901-1905 

601,000 

30.9 

Source: 

Annuario  de  Estatistica  Demo- 

grapho-Sanitaria  da  Cidade  do 

Salvador 

(Bahia),  1900-1908. 

Boletin 

Mensal   de 

Estatistica   Demo- 

grapho-Sanitaria  da  Cidade  do 

Salvador, 

1909-1911. 

Table  350 

Mortality  from  Cancer  in  the  City  of  Bahia,  by  Organs  and  Parts 

according  to  Sex,  1904-1908 


MALES 


Organ  or  Part 

Buccal  cavity 

Stomach 

Liver 

Peritoneum,  intestines,  rectum . 

Femal©  generative  organs 

Breast 

Skin 

Other  or  not  specified  organs 

All  organs 


Deaths 

from 

Cancer 

Rate  per 

100,000 

Population 

15 

13 

6 

9 

2.5 
2.2 
1.0 
1.5 

8 
34 

1.3 

5.7 

85 


14.2 


FEMALES 

Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

3 

0.5 

9 

1.4 

9 

1.4 

10 

1.5 

94 

14.2 

20 

3.0 

6 

0.9 

71 

10.7 

33.6 


Source:     Annuario    de   Estatistica   Demographo-Sanitaria    da    Cidade    do    Salvador 
(Bahia) . 


765 


APPENDIX  G 


Table  351 

Mortality  from  Cancer  in  the  City  of  Sao  Paulo 

1896-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1896 

169,864 

61 

35.9 

1906 

288,000 

80 

27.8 

1897 

187,353 

51 

27.2 

1907 

296,000 

128 

43.2 

1898 

204,842 

57 

27.8 

1908 

304,000 

143 

47.0 

1899 

222,331 

48 

21.6 

1909 

312,000 

117 

37.5 

1900 

239,820 

52 

269 

21.7 
26.3 

1910 
1906-1910 

320,000 

153 
621 

47.8 

1896-1900 

1,024,210 

1,520,000 

40.9 

1901 

248,000 

66 

26.6 

1911 

358,000 

156 

43.6 

1902 

256,000 

68 

26.6 

1912 

400,000 

200 

50.0 

1903 

264,000 

84 

31.8 

1913 

450,000 

201 

44.7 

1904 

272,000 

100 

36.8 

1905 

280,000 

89 

31.8 

Source: 

Estado  de  Sao  Paulo.     Direc- 

toria     do     Servigo     S 
Demographico,  1901-1 

Annuario 

1901-1905 

1,320.000 

407 

30.8 

912. 

Table  352 

Mortality  from  Cancer  in  the 

City  of  Sao  Paulo,  Males 

1901-1913 


Year  Population 


Deaths         Rate  per 


1901 
1902 
1903 
1904 
1905 


129,000 
133,000 
137,000 
141,000 
146,000 


1901-1905    686,000 


1906 
1907 
1908 
1909 
1910 


150,000 
155,000 
160,000 
164,000 
168,000 


1906-1910   797,000 


1911 

1912 
1913 


188,000 
210,000 
235,000 


from 
Cancer 

26 
32 
42 
55 
42 

197 

36 

72 
72 
59 
77 

316 

84 
102 
107 


100,000 
Population 

20.2 
24.1 
30.7 
39.0 

28.8 

28.7 

24.0 
46.5 
45.0 
36.0 

45.8 

39.6 

44.7 
48.6 
45.5 


Source:  Estado  de  Sao  Paulo.  Direc- 
toria  do  Servigo  Sanitario.  Annuario 
Demographico,  1901-1912. 


Table  353 

Mortality  from  Cancer  in  the 

City  of  Sao  Paulo,  Females 

1901-1913 


Year 

1901 
1902 
1903 
1904 
1905 


Population 

119,000 
123,000 
127,000 
131,000 
134,000 


1901-1905    634,000 


1906 
1907 
1908 
1909 
1910 


138,000 
141,000 
144,000 
148,000 
152,000 


1906-1910   723,000 


1911 
1912 
1913 


170,000 
190,000 
215,000 


Deaths 
from 
Cancer 

40 
36 
42 
45 
47 

210 

44 

56 
71 
58 
76 

305 

72 
98 
94 


Rate  per 

100,000 

Population 

33.6 
29.3 
33.1 
34.4 
35.1 

33.1 

31.9 
39.7 
49.3 
39.2 
50.0 

42.2 

42.4 
51.6 
43.7 


Soiu"ce:  Estado  de  Sao  Paulo.  Direc- 
toria  do  Ser\dQO  Sanitario.  Annuario 
Demographico,  1901-1912. 


766 


APPENDIX  G 


Table  354 

Table  357 

Mortality  from 

Cancer  i 

n  the 

Mortality  from  Cancer  in  th 

e  Prov- 

State  of  Parana 

ince  of  Buenos  Aires,  Argentina 

1906- 

1910 

Rate  per 

1895-19 

12 

Deaths 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1906 

351,341 

37 

10.5 

1895 

910,664 

370 

40.6 

1907 

355,761. 

32 

9.0 

1908 

368,985 

45 

12.2 

1896 

955,258 

438 

45.9 

1909 

380,000 

38 

10.0 

1897 

1,025,012 

496 

48.4 

1910 

400,000 

40 

10.0 

1898 

1,074,119 

511 

47.6 

1899 

1,122,549 
1,177,381 

525 

46.8 

1906-1910 

1,856,087 
Relatorie 

192            10.3 
pelo  el  Director  de 

1900 
1896-1900 

627 

53.3 

Source: 

5,354,319 

2,597 

48.5 

Service  Sanitario  do 

Parana; 

accempan- 

hado  da  Estatistica  Demographo 

-Sanitaria. 

1901 

1,231,453 

021 

50.4 

1902 

1,269,452 

056 

51.7 

Table  355 

1903 
1904 

1,295,810 
1,331,959 

715 

759 

55.2 
57.0 

Mortality  from  Cancer 

in  the 

1905 

1,379,191 

882 

64.0 

City  of  ] 
1906- 

*elotas 

1913 

Rate  per 

100,000 

Population 

1901-1905 

1906 
1907 

6,507,865 

1,462,287 

1,527,897 

3,633 

896 
921 

55.8 

Year 

Population 

Deaths 
from 
Cancer 

61.3 
60.3 

1906 

32,308 

27 

83.6 

1908 

1,600,465 

994 

62.1 

1907 

33,290 

38 

114.1 

1909 

1,684,642 

1,053 

62.5 

1908 

34,272 
35,254 

29 
37 

84.6 
105.0 

1910 

1,865,192 

1,084 

58.1 

1909 

1910 

36,243 

26 
157 

71.7 
91.6 

1906-1910 
1911 

8,140,483 
1,950,785 

4,948 
1,015 

60.8 

1906-1910 

171,367 

52.0 

1912 

2,069,610 

1,100 

53.2 

1911 
1912 

37,225 
38,207 

28 

27 

75.2 

70.7 

Source: 

Direccion  General  de 

Estadis- 

1913 

39,189 

25 

63.8 

tica    de    la    Provincia 

de    Buenos  Aires: 

Memoria  Demographics 

,  1895. 

Source: 

Municipio 

de     Pelotas.     Re- 

Anuario 

Estadistico, 

1896-1897. 

latorio  apresentado  ao 

Censelhe  Municipal, 

Demographia,  1898-1905. 

1906-1913. 

Boletin 

Mensual    de 

la    Direccion    de 

Estadistica 

,   1906-1912. 

Table  356 

Mortality  from  Cancer 

in  the 

City  of  Belle 

Horizonte 

1910- 

1912 

Rate  per 

Deaths 

Year 

Population 

from 
Cancer 

100,000 
Population 

1910 

35,000 

8 

22.9 

1911 

37,435 

17 

45.4 

1912 

39,845 

16 

41 

40.2 
36.5 

1910-1912 

112,280 

Source: 

Annuario  de  Estatis 

tica  Deme- 

grapho-Sanitaria  de  Belle  Horizente. 

767 


APPENDIX  G 


.  Table  358 

Mortality  from  Cancer  in  the  Province  of  Buenos  Aires,  Males 

1895-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1895 

512,431 

209 

40.8 

1906 

823,268 

543 

66.0 

1907 

860,206 

554 

64.4 

1896 

537,524 

247 

46.0 

1908 

901,061 

588 

65.3 

1897 

576,774 

279 

48.4 

1999 

950,138 

653 

68.7 

1898 
1899 

604,407 
631,658 

305 

286 

50.5 

45.3 

1910 

1,051,968 

634 

60.3 

1900 

662,865 

397 

59.9 
50.2 

1906-1910 
1911 

4,586,641 
1,100,243 

2,972 
589 

64.8 

1896-1900 

3,013,228 

1,514 

53.5 

1912 

1,167,260 

647 

55.4 

1901 

693,308 

342 

49.3 

1902 

714,701 

379 

53.0 

Source: 

Direccion  General  de 

Estadis- 

1903 

729,541 

426 

58.4 

tica    de    la 

Provincia 

de    Buencs    Aires : 

1904 

749,893 

462 

61.6 

Memoria  Demographica,  1895. 

1905 

776,484 

533 

68.6 

Anuario  Estadistico, 

1896-1897. 

DpmnoTai->V.;Q      ISOS-IOOt 

1901-1905 

3,663,927 

2,142 

58.5 

Boletin 

Mensual    de 

la    Direccion    de 

Estadistica 

,  1906-1912. 

Table  359 
Mortality  from  Cancer  in  the  Province  of  Buenos  Aires,  Females 

1895-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1895 

398,233 

161 

40.4 

1906 

639,019 

353 

55.2 

1907 

667,691 

367 

55.0 

1896 

417,734 

191 

45.7 

1908 

699,404 

406 

58.0 

1897 

448,238 

217 

48.4 

1909 

734,504 

400 

54.5 

1898 

469,712 

206 

43.9 

1910 

813,224 

450 

55.3 

1899 

490,891 

239 

48.7 

1900 

514,516 

230 

44.7 
46.3 

1906-1910 
1911 

3,553,842 
850,542 

1,976 

426 

55.6 

1896-1900 

2,341,091 

1,083 

50.1 

1912 

902,350 

453 

50.2 

1901 

538,145 

279 

51.8 

1902 

554,751 

277 

49.9 

Source: 

Direccion 

General  de 

Estadis- 

1903 

566,269 

289 

51.0 

tica  de   la 

Provincia 

de    Buenos    Aires : 

1904 

582,066 

297 

51.0 

Memoria  Demographica,  1895. 

1905 

602,707 

349 

57.9 

Anuario 

Estadistico, 

1896-1897 

Demographia,   1898-1905. 

1901-1905 

2,843,938 

1,491 

52.4 

Boletin 

Mensual    de    la    Direccion    de 

Estadistica 

,  1906-1912. 

768 


APPENDIX  G 

Table  360 

Mortality  from  Cancer  in  the  City  of  Buenos  Aires 

1882-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1882 

362,373 

192 

53.0 

1901 

854,988 

723 

84.6 

1883 

376,573 

177 

47.0 

1902 

886,986 

763 

86.0 

1884 

390,773 

170 

43.5 

1903 

918,984 

864 

94.0 

1885 

404,973 

218 

53.8 

1904 

950,981 

890 

93.6 

1886 

419,173 

213 

50.8 
49.6 

1905 
1901-1905 

1,007,124 

950 

94.3 

1882-188G 

1,953,865 

970 

4,619,063 

4,190 

90.7 

1889 

490,779 

352 

71.7 

1906 

1,063,267 

982 

92.4 

1890 

519,482 

308 

59.3 

1907 

1,119,410 

983 

87.8 

1908 

1,175,553 

1,030 

87.6 

1891 

548,185 

324 

59.1 

1909 

1,231,698 

1,026 

83.3 

1892 

576,888 

370 

64.1 

1910 

1,282,353 

1,034 

80.6 

1893 

605,591 

427 

70.5 

1894 

634,293 

442 

69.7 

1906-1910 

5,872,281 

5,055 

86.1 

1895 

663,000 

461 

69.5 

1911 

1,333,008 

1,175 

88.1 

1891-1895 

3,027,957 

2,024 

66.8 

1912 

1,383,663 

1,210 

87.4 

1913 

1,434,318 

1,266 

88.3 

1896 

694,998 

514 

74.0 

1897 

726,996 

629 

86.5 

Source: 

Year-Book 

of    the 

City    of 

1898 

758,994 

554 

73.0 

Buenos  Aires. 

1899 

790,992 

614 

77.6 

1900 

822,990 

748 

90.9 
80.6 

k 

1896-1900 

3,794,970 

3,059 

Table  361 

Mortality  from  Cancer  in  the  City  of  Buenos  Aires,  Males 

1896-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1896 

372,102 

301 

80.9 

1906 

558,640 

607 

108.7 

1897 

388,070 

359 

92.5 

1907 

589,593 

584 

99.1 

1898 

403,937 

314 

77.7 

1908 

620,692 

632 

101.8 

1899 

419,700 

351 

83.6 

1909 

651,938 

617 

94.6 

1900 

435,362 

439 

100.8 
87.4 

1910 
1906-1910 

680,416 

622 

91.4 

1896-1900 

2,019,171 

1,764 

3,101,279 

3,062 

98.7 

1901 

451,006 

441 

97.8 

1911 

708,361 

733 

103.5 

1902 

466,555 

485 

104.0 

1912 

736,109 

720 

97.8 

1903 

482,007 

503 

104.4 

1913 

763,660 

742 

97.2 

1904 

497,363 

548 

110.2 

1905 

527,934 

562 

106.5 

Source : 

Year-Book 

of    the 

City    of 

Tiny-i»-»/-.C7       Ai-M/^o 

1901-1905 

2,424,865 

2,539 

104.7 

769 


APPENDIX  G 


Table  362 
Mortality  from  Cancer  in  the  City  of  Buenos  Aires,  Females 

1896-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1896 

322,896 

213 

66.0 

1906 

504,627 

375 

74.3 

1897 

338,926 

270 

79.7 

1907 

529,817 

399 

75.3 

1898 

355,057 

240 

67.6 

1908 

554,861 

398 

71.7 

1899 

371,292 

263 

70.8 

1909 

579,760 

409 

70.5 

1900 

387,628 

309 

79.7 
72.9 

1910 
1906-1910 

601,937 

412 

68.4 

1896-1900 

1,775,799 

1,295 

2,771,002 

1,993 

71.9 

1901 

403,982 

282 

69.8 

1911 

624,647 

442 

70.8 

1902 

420,431 

278 

66.1 

1912 

647,554 

490 

75.7 

1903 

436,977 

361 

82.6 

1913 

670,658 

524 

78.1 

1904 

453,618 

342 

75.4 

1905 

479,190 

388 

81.0 

Source : 

Year-Book 

of    the 

City    of 

1901-1905 

2,194,198 

1,651 

75.2 

Table  363 

Mortality  from  Cancer  in  the  City  of  Buenos  Aires,  by  Organs  and  Parts 

according  to  Sex,  1907-1911 


MALES 

•                                                                      Deaths  Rate  per 

Organ  or  Part                                   from  100,000 

Cancer  Population 

Buccal  cavity 210  6.46 

Stomach  and  liver 1,740  53.52 

Peritoneum,  intestines,  rectum .  .        147  4.52 

Female  generative  organs 

Breast 

Skin 66  2.03 

Other  or  not  specified  organs 1,025  31.53 

All  organs 3,188  98.06 

Source :     Year-Book  of  the  City  of  Buenos  Aires. 


FEMALES 

Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

33 

1.14 

677 

23.42 

131 

4.53 

532 

18.40 

137 

4.74 

24 

0.83 

526 

18.19 

2,060 


71.25 


770 


APPENDIX  G 


Table  364 

Table  366 

Mortality  from  Cancer  in  the 

City  of 

Mortality  from  Cancer  in  th 

e  City  of 

Rosario  de 

Santa  Fe 

Rosario  de  Santa  Fe,  Females 

1904- 

1913 

Rate  per 

1904-1911 

Deaths 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Caacer 

Population 

Cancer 

Population 

1904 

128,078 

83 

64.8 

1904 

59,479 

38 

63.9 

1905 

130,565 

91 

69.7 

1905 

60,595 

41 

67.7 

1906 

141,127 

123 

87.2 

1906 

65,455 

47 

71.8 

1907 

151,887 

91 

59.9 

1907 

70,400 

39 

55.4 

1908 

160,225 

112 

69.9 

1908 

74,216 

50 

67.4 

1909 

171,796 

121 

70.4 

1909 

79,507 

51 

64.1 

1910 

187,428 

156 
603 

83.2 

74.2 

1910 
1906-1910 

86,667 

72 
259 

83.1 

1906-1910 

812,463 

376,245 

68.8 

1911 

203,886 

145 

71.1 

1911 

94,195 

57 

60.5 

1912 

214,269 

150 

70.0 

1913 

225,600 

138 

61.2 

Source: 

Anuario 

Estadistico    de    la 

Ciudad  del  Rosario  de  Santa  Fe. 

Source : 

Anuario    Estadisticc 
Rosario  de  Santa  Fe. 

)    de    la 

Ciudad  del 

Boletin  Mensual  de  Estadistica 

Munici- 

Table  367 

pal  de  la  Ciudad  del  Rosario  de  Santa  Fe. 

Mortality  from  Cancer  in  the  Prov- 

ince  of  Tucuman 
1901-1912 

Table  365 
from  Cancer  in  the 

Cityof 

Mortality 

Deaths 

Rate  per 

Rosario  de  Santa  Fe,  Males 

Year 

Population 

from 

100,000 

1904-] 

1911 

Cancer 

Population 

Rate  per 

1901 
1902 

252,098 

254,762 

46 
44 

18.2 

Deaths 

17.3 

Year 

Population 

from 

100,000 

1903 

257,427 

47 

18.3 

Cancer 

'opulation 

1904 

263,079 

40 

15.2 

1904 

68,599 

45 

65.6 

1905 

269,617 

39 

14.4 

1905 

69,970 

50 

71.5 

1901-1905 

1,296,983 

216 

16.7 

1906 

75,672 

76 

100.4 

1907 

81,487 

52 

63.8 

1906 

291,230 

39 

13.4 

1908 

86,009 

62 

72.1 

1907 

299,241 

36 

12.0 

1909 

92,289 

70 

75.8 

1908 

311,600 

48 

15.4 

1910 

100,761 

84 

83.4 

1909 

312,519 

55 

17.6 

1910 

320,933 

57 

17.8 

1906-1910 

436,218 

344 

79.0 

1906-1910 

1,535,523 

235 

15.3 

1911 

109,691 

88 

80.2 

1911 

325,209 

62 

19.1 

Source : 

Anuario 

Estadisticc 

de    la 

1912 

329,485 

75 

22.8 

Ciudad  del  Rosario  de  Santa  Fe. 

Source : 

Anuario  de 

Estadistica  de  la 

Provincia 

de  Tucuman 

correspondiente  al 

Ano  de  1910. 

771 


APPENDIX  G 

Table  368 

Mortality  from  Cancer  in  the  City  of  Santiago  del  Estero 

1891-1913 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1891 

11,805 

2 

16.9 

1906 

16,578 

4 

24.1 

1892 

12,036 

3 

24.9 

1907 

17,170 

16 

93.2 

1893 

12,272 

5 

40.7 

1908 

17,852 

11 

61.6 

1894 

12,512 

6 

48.0 

1909 

18,534 

3 

16.2 

1895 

12,892 

6 

22 

46.5 
35.8 

1910 
1906-1910 

19,216 

8 
42 

41.6 

1891-1895 

61.517 

89,350 

47.0 

1896 

13,324 

12 

90.1 

1911 

19,898 

3 

15.1 

1897 

13,657 

9 

65.9 

1912 

20,580 

11 

53.4 

1898 

13,989 

6 

42.9 

1913 

21,262 

8 

37.6 

1899 

14,290 

2 

14.0 

1900 

14,698 

1 

6.8 

Source: 

Direccion 

General  de  Estadis- 

1896-1900 

69,958 

30 

42.9 

Santiago  del  Estero. 

Mortalidad  General, 

1890-1908. 

1901 

15,066 

7 

46.5 

1909-1913  by  correspondence 

with  Di- 

1902 

15,339 

6 

39.1 

reccion  General  de  Estadistica  j 

'  Registro 

1903 

15,556 

Civil,  Santiago  del  Estero. 

1904 

15,827 

6 

31.6 

1905. 

16,168 

7 
25 

43.3 
32.1 

1901-1905 

77,956 

Table  369 

Mortality  from  Cancer  in  the  Republic  of  Chile 

1892-1912 


Deaths 

Rate  per 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1892 

2,645,408 

457 

17.3 

1906 

3,202,510 

1,209 

37.8 

1893 

2,664,190 

455 

17.1 

1907 

3,249,279 

1,251 

38.5 

1894 

2,683,105 

546 

20.3 

1908 

3,297,585 

1,434 

43.5 

1895 

2,712,145 

426 

15.7 

1909 

3,347,124 

1,369 

40.9 

1896 

2,753,369 

554 

20.1 
18.1 

1910 
1906-1910 

3,415,060 

1,089 

31.9 

1892-1896 

13,458,217 

2,438 

16.511,558 

6,352 

38.5 

1903 

3,060,807 

894 

29.2 

1911 

3,483,000 

1,031 

29.6 

1904 

3,107,331 

1,194 

38.4 

1912 

3,505,017 

1,154 

32.9 

1905 

3,154,561 

954 

30.2 

Source: 
publica  d 

PnV.lar>TnTl     On\mt\nAn     Aa    lo     TJo- 

1903-1905 

9,322,699 

3,042 

32.6 

5  Chile  en 

1910  i   Resena  del 

Movimiento  de  Poblacion  del  mismo  ano. 

Santiago  del  Chile,  1912. 

* 

Report  of  the  Regist 

rar-General  for  Eng- 

land  and  Wales,  1912. 

772 


APPENDIX  G 


Table  370 

Table  371 

Mortality 

from  Cancer  in  the  Prov- 

Mortality  from  Cancer  in  th 

le  City 

ince 

of  Santiago  de  Chile 

of  Santiago 

de  Chile 

1904-19 

12 

Deaths 

Rate  per 

1898-1909 

Deaths 

Rate  per 

Year 

Population 

from 

100,000 

Year 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1904 

487,021 

266 

54.6 

1898 

270,704 

250 

92.4 

1905 

496,904 

321 

64.6 

1899 

275,638 

272 

98.7 

1900 

281,886 

296 

105.0 

1906 

506,887 

406 

80.1 

1901 

288,645 

222 

76.9 

1907 

616,870 

301 

58.2 

1902 

295,059 

230 

78.0 

1908 

526,853 
536,836 

301 
399 

57.1 
74.3 

1909 

1898-1902 

1,411,932 

1,270 

89.9 

1910 

546,819 

373 

68.2 

1903 

302,538 

251 

83.0 

1906-1910 

2,634,265 

1,780 

67.6 

1904 

309,510 

223 

72.0 

1905 

317,420 

233 

73.4 

1911 

556,803 

270 

48.5 

1906 

324,057 

204 

63.0 

1912 

566,787            328            57.9 
Correspondence    from    Direc- 

1907 
1903-1907 

332,724 

218 

65.5 

Source: 

1,586,249 

1,129 

71.2 

cioQ  General  de  Estadistica  de  Chile. 

1908 

340,210 

234 

68.8 

1909 

347,864 

293 

84.2 

Source: 

Correspond 

ence    from 

Direc- 

cion  General  de  Estadistica  de  Chile. 

Table  372 
Mortality  from  Cancer  in  the  City  of  Santiago  de  Chile,  by  Organs  and  Parts 

1898-1902 

Organ  or  Part                                                                                                   No.  of  Deaths  Per  Cent. 

Head 2  0.26 

Face 10  1.31 

Lips 1  0.13 

Mouth  and  tongue 17  2.22 

Jaw 2  0.26 

Larynx  and  throat 12  1.57 

Spine 2  0.26 

Lungs 6  0.78 

CEsophagus 7  0.91 

Stomach 367  47.91 

Rectum 20  2.61 

Other  intestines 40  5.22 

Liver 117  15.29 

Kidney,  spleen  and  pancreas 8  1.04 

Bladder 14  1.83 

Uterus  and  ovaries 89  11.62 

Breast 9  1.17 

Not  specified 43  5.61 

All  organs 766  100.00 

Source:     Zeltschrift  f iir  Krebsforschung.     3.  Band. 
Note:     Includes  carcinoma  only. 


773 


APPENDIX  G 

Table  373 

Mortality  from  Cancer  in  the  Republic  of  Uruguay 

1891-1913 


Year 

Population 

Deaths 

from 
Cancer 

Rate  per 

100,000 

Population 

Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1891 

708,168 

277 

39.1 

1901 

931,527 

495 

53.1 

1892 

728,447 

335 

46.0 

1902 

947,407 

481 

50.8 

1893 

748,130 

346 

46.2 

1903 

963,287 

501 

52.0 

1894 

776,314 

340 

43.8 

1904 

979,166 

531 

54.2 

1895 

792,800 

350 

44.1 
43.9 

1905 
1901-1905 

995,046 

587 

59.0 

1891-1895 

3,753,859 

1,648 

4,816,433 

2,595 

53.9 

1896 

818,843 

411 

50.2 

1906 

1,010,926 

667 

66.0 

1897 

827,485 

401 

48.5 

1907 

1,026,806 

695 

67.7 

1898 

840,725 

481 

57.2 

1908 

1,042,686 

662 

63.5 

1899 

878,186 

468 

53.3 

1909 

1,080,070 

704 

65.2 

1900 

915,647 

423 

46.2 
51.0 

1910 
1906-1910 

1,117,454 

757 

67.7 

1896-1900 

4,280,886 

2,184 

5,277,942 

3,485 

66.0 

1911 

1,154,838 

732 

63.4 

1912 

1,192,222 

838 

70.3 

1913 

1,229,606 

903 

73.4 

Source: 

Anuario  Estadistico  de  la  Re- 

publica  Oriental  del  Uruguay. 

Table  374 

Table  375 

Mortality  from  Cancer  in  the  Repub- 
lic of  Uruguay,  Males 

Mortality  from  Cancer  in  the  Repub- 
lic of  Uruguay,  Females 

1905-1912 

Rate  per 

100,000 

Population 

Year 

1905-19 

12 

Deaths 
from 
Cancer 

Year 

Population 

Deaths 
from 
Cancer 

Population 

Rate  per 

100,000 

Population 

1905 

506,279 

340 

67.2 

1905 

488,767 

247 

50.5 

1906 

514,359 

375 

72.9 

1906 

496,567 

292 

58.8 

1907 

522,439 

395 

75.6 

1907 

504,367 

300 

59.5 

1908 

530,519 

389 

73.3 

1908 

512,167 

273 

53.3 

1909 

549,540 

396 

72.1 

1909 

530,530 

308 

58.1 

1910 

568,561 

429 

75.5 
73.9 

1910 
1906-1910 

548,893 

355 

64.7 

1906-1910 

2,685,418 

1,984 

2,592,524 

1,528 

58.9 

1911 

587,582 

431 

73.4 

1911 

567,256 

301 

53.1 

1912 

606,603 

477 

78.6 

1912 

585,619 

361 

61.6 

Source : 

Anuario  Estadistico  de  la  Re- 

Source: 

Anuario  Estadistico 

de  la  Re- 

publica  Oriental  del  Uruguay. 

publica  Oriental  del  Uruguay. 

W4 


APPENDIX  G 

Table  376 

Mortality  from  Cancer  in  the  Republic  of  Uruguay,  by   Organs  and  Parts 

according  to  Sex.     Rate  per  100,000  of  Population 

1906-1910 

Organ  or  Part  Persons  Males  Females 

Buccal  cavity 2.0  3.6  0.4 

Stomach  and  liver 35.6  44.4  26.5 

Peritoneum,  intestines  and  rectum 4.6  4.2  4.9 

Female  generative  organs , 6.0  .  .  12.2 

Breast 1.8  .  .  3.7 

Skin 1.1  1.6  0.5 

Other  or  not  specified  organs 14.9  19.4  10.4 

All  organs 66.0  73.2  58.6 

Source:     Anuario  Estadistico  de  la  Republica  Oriental  del  Uruguay. 

Table  377 

Mortality  from  Cancer  in  the  City  of  Montevideo 

1903-1913 


Year 

Population 

Deaths 
from 
Cancer 

Rate  per 

100,000 

Population 

1903 
1904 
1905 

282,689 
289,018 
298,533 

295 
260 
320 

104.4 

90.0 

107.2 

1906 
1907 
1908 
1909 
1910 

307,482 
309,904 
313,016 
321,224 
329,888 

347 
385 
364 
403 
406 

112.9 
124.2 
116.3 
125.5 
123.1 

1906-1910 

1,581,514 

1,905 

120.5 

1911 
1912 
1913 

338,353 
355,017 
370,000 

364 
400 
450 

107.6 
126.7 
121.6 

Source:     Resumen  Anual  de  Estadistica 
Municipal,  Montevideo. 


Table  378 
Mortality  from  Cancer  in  the  City  of  Montevideo,  by  Organs  and  Parts 

1907-1911 

Deaths  Rate  per 

Organ  or  Part                                                                                                    from  100,000 

Cancer  Population 

Buccal  cavity 57  3.5 

Stomach  and  liver 1,030  63.9 

Peritoneum,  intestines  and  rectum 128  7.9 

Female  generative  organs 172  10.7 

Breast 53  3.3 

Skin 20  1.2 

Other  or  not  specified  organs 462  28.7 

All  organs 1,922  119.2 

Source:    Resimien  Anual  de  Estadistica  Municipal,  Montevideo. 


775 


APPENDIX 

H 

Recommendations  and  Instructions 
ON  THE  Control  of  Cancer 


Table  Page 

1  Recommendations  to  The  American  Gynecological  Society  for  the  National 

Control  of  Cancer,  by  Frederick  L.  Hoffman 777 

2  Purpose  and  Methods  of  Work  of  The  American  Society  for  the  Control  of 

Cancer 779 

3  Instructions  on  Prevention  of  Cancer  Issued  by  the  Borough  of  Portsmouth, 

England 781 

i     Report  on  the  Prevention  of  Cancer  of  the  Medical.  Officer  of  Health  of  the 

Borough  of  Shelf,  England 783 


776 


APPENDIX  H 

Table  1 

Recommendations  to  The  American  Gynecological  Society,  May  7,  1913,  for 

the  National  Control  of  Cancer,  by  Frederick  L.  Hoffman 


RECOMMENDATIONS 

1.  The  organization  of  an  American  society*  for  the  study  and  pre- 
vention of  cancer,  primarily  for  the  purpose  of  educating  the  pubUc 
at  large  in  the  absolute  necessity  of  operative  treatment  at  the  earliest 
indications  of  cancerous  growths. 

2.  A  thorough  investigation  into  the  geographical  distribution  of 
cancer  throughout  the  western  hemisphere,  but  with  special  reference 
to  localities  and  sections  which  persistently  show  a  very  high  or  a 
very  low  rate  of  cancer  mortality. 

3.  A  thoroughly  qualified  medical  and  statistical  investigation  into 
the  cancer  experience  data  of  general  and  cancer  hospitals  for  a  period 
of  sufficient  length  to  determine  the  precise  results  of  medical  and  surgi- 
cal treatment,  with  a  due  regard  to  the  after-lifetime,  possible  recur- 
rence, or  subsequent  death  of  patients  discharged  as  cured  or  materially 
improved. 

4.  A  nation-wide  agitation  for  a  material  improvement  and  required 
completeness  of  the  official  returns  of  deaths  from  cancer,  with  a  due 
regard  to  the  organs  or  parts  affected,  for  the  purpose  of  reducing  the 
number  and  proportion  of  unclassified  or  ill-defined  cancers  to  the  lowest 
possible  minimum. 

5.  The  Division  of  Vital  Statistics  of  the  Census,  as  well  as  all  state 
and  municipal  boards  of  health  in  charge  of  the  registration,  tabulation, 
and  analysis  of  vital  statistics  should  be  urged  to  redistribute  the  deaths 
occurring  in  institutions,  according  to  the  permanent  or  regular  resi- 
dence of  the  deceased.  Only  by  means  of  such  a  correction  can  the 
true  local  incidence  of  cancer  be  established,  as  has  been  shown  with 
admirable  clearness  by  the  investigations  of  Green,  of  Edinburgh. 

6.  A  thoroughly  scientific  investigation,  through  the  cooperation 
of  the  Census  Office,  the  Bureau  of  Labor,  the  Bureau  of  Mines,  life 
insurance  companies,  etc.,  should  be  made  into  the  occupational  inci- 
dence of  cancer,  with  regard  to  which  there  are  strong  reasons  for 
believing  that  a  wealth  of  useful  information  can  be  brought  to  light 
which  is  at  present  unavailable. 

7.  Since  an  erroneous  diet  is  a  probable  causative  factor  in  cancer 
occurrence,  the  nutrition  of  cancerous  patients  should  be  investigated 
in  conformity  to  the  strictly  scientific  and  conclusive  methods  of  Pro- 
fessors Atwater  and  Chittenden. 

*"The  American  Society  for  the  Control  of  Cancer"  was  formed  in  the  city  of  New  York  on  May  22,  1913. 

777 


APPENDIX  H 

Table  1  (concluded) 

Recommendations  to  The  American  Gynecological  Society,  May  7,  1913,  for 

the  National  Control  of  Cancer,  by  Frederick  L.  Hoffman 

8.  As  an  aid  in  the  scientific  study  of  cancer,  and  as  a  possible  means 
of  bringing  about  a  more  intelligent  public  understanding  of  the  accepted 
facts  of  cancer  occurrence,  its  nature  and  probable  cure,  the  disease 
should  be  made  reportable  to  the  local  Board  of  Health  in  the  same 
manner  as  other  diseases  which  are  a  recognized  menace  to  public 
health  and  welfare. 

9.  As  a  further  aid,  the  Department  of  Agriculture  should  be  re- 
quested to  make  a  thorough  study  of  the  occurrence  of  cancer  among 
domestic  animals  and  plants  known,  or  suspected,  to  be  subject  thereto, 
and  such  an  investigation  should,  as  far  as  practicable,  be  coordinated 
to  the  work  of  the  Bureau  of  Soils. 

10.  The  immediate  preparation  and  widest  possible  distribution  of 
a  concise  outline  of  accepted  cancer  facts,  showing  the  disease  in  all 
eases  to  be  of  local  origin,  that  the  chief  danger  to  the  patient  Kes  in  the 
tendency  toward  a  rapid  extension  of  cancerous  growths,  that  the  only 
certain  remedy  known  to  science  i's  the  complete  surgical  removal 
of  the  affected  parts  at  the  earliest  possible  indication  of  the  disease, 
and  that  when  this  is  done  the  outlook  for  a  cure  in  the  accepted  sense 
of  the  term  is  decidedly  hopeful,  but  that  to  the  contrary  delay  and 
neglect,  or  refusal  to  submit  to  operative  treatment,  are  practically 
certain  to  result  fatally  within  a  comparatively  short  period  of  time. 


778 


APPENDIX  H 

Table  2 

Purpose  and  Methods  of  Work  of  The  AmericarL  Society 

for  the  Control  of  Cancer 


The  American  Society  for  the  Control  of  Cancer 

PURPOSE 

"To  disseminate  knowledge  concerning  the  symptoms,  diagnosis, 
treatment  and  prevention  of  cancer,  to  investigate  the  conditions  under 
which  cancer  is  found  and  to  compile  statistics  in  regard  thereto." 

ITS  PROBLEM 

Cancer  is  one  of  the  chief  causes  of  death.  It  claims  about  75,000 
lives  every  year  in  the  United  States.  At  ages  over  forty  the  disease 
causes  one  death  in  eight  among  women,  and  one  death  in  fourteen 
among  men.  It  is  preeminently  a  disease  of  adult  life,  and  at  ages  over 
forty  is  a  greater  menace  than  tuberculosis  or  pneumonia.  Its  insidious 
onset  often  occurs  at  the  most  useful  period  of  life,  when  the  father  and 
mother  are  of  the  greatest  service  to  society. 

ITS  OPPORTUNITY 

Much  is  known  about  cancer,  but  the  present  knowledge  is  not  suf- 
ficiently utilized.  Cancer  is  not  a  constitutional  or  blood  disease,  but 
is  at  first  a  local  growth,  which  can  at  that  time  be  easily  removed  by 
prompt  surgical  operation.  This  is  the  only  known  cure,  and  the  chief 
hope  of  controlling  the  disease  lies  in  a  careful  campaign  of  public 
education  in  regard  to  the  many  well-known  conditions  under  which 
cancer  develops,  the  first  signs,  and  the  vital  importance  of  its  early 
recognition  and  prompt  removal. 

ITS  ORGANIZATION  AND  AIMS 

The  American  Society  for  the  Control  of  Cancer  was  established  by  a 
group  of  prominent  men  and  women  who  were  deeply  impressed  by 
these  facts  and  saw  the  need  of  a  national  agency  to  conduct  statistical 
investigations,  organize  local  campaigns  and  promote  educational  work 
in  this  field  similar  to  that  of  the  National  Association  for  the  Study 
and  Prevention  of  Tuberculosis. 

Biological  research,  the  treatment  of  individual  cases  and  the  main- 
tenance of  hospitals  or  clinics  are  not  comprehended  in  the  design  of  the 
Society.     Educational  publicity  is  the  first  and  the  chief  object. 

'  ITS  ENDORSEMENTS 

The  Society  has  received  the  official  approval  of  the  American  Medical 
Association,  the  American  Surgical  Association,  the  American  Gynecolog- 
ical Society,  the  Clinical  Congress  of  Surgeons,  the  Western  and  South- 
ern Surgical  Associations  and  the  various  special  medical  societies  of 
national  scope  which  together  constitute  the  American  Congress  of 
Physicians  and  Surgeons.  Numerous  state  and  local  medical  societies 
have  also  given  their  endorsement  and  their  active  assistance  in  the  work. 

779 


APPENDIX  H 

Table  2  (concluded) 

Purpose  and  Methods  of  Work  of  The  American  Society 

for  the  Control  of  Cancer* 

Methods  of  Work 

PUBLICITY  AND  EDUCATION 

A  press  bureau,  carefully  supervised  by  distinguished  medical  experts, 
causes  the  regular  publication  of  instructive  articles  in  a  large  number 
of  newspapers  all  over  the  country. 

Special  articles  are  prepared  for  medical  journals,  health  department 
bulletins  and  popular  magazines.  Leaflets  and  circulars  are  printed 
and  distributed  by  mail,  at  meetings  and  through  local  agencies.  The 
cooperation  of  boards  of  health,  insurance  companies,  womens'  clubs, 
industrial  and  welfare  organizations  and  similar  agencies  is  obtained 
and  much  additional  educational  work  is  thus  stimulated. 

MEETINGS  AND  LECTURES 

Large  public  meetings  have  been  organized  in  Chicago,  St.  Louis, 
Pittsburgh,  Boston,  Portland,  New  York  and  other  cities. 

A  lecture  bureau  has  been  established,  and  well-qualified  speakers 
are  supplied  without  expense  for  these  and  smaller  meetings  under  the 
auspices  of  appropriate  organizations. 

Special  effort  is  made  to  instruct  nurses  and  social  workers  as  to  the 
elementary  facts  about  cancer,  in  order  that  they  may  spread  this 
necessary  and  life-saving  knowledge  among  the  people,  especially 
women,  with  whom  they  come  in  contact  in  the  course  of  their  duties. 

LOCAL  WORK 

Branch  committees  of  the  National  Society  are  set  up  in  every  city 
where  the  interest  warrants  such  action.  In  organizing  local  campaigns 
the  cooperation  of  state  and  city  boards  of  health  is  particularly  sought 
and  health  officials  are  furnished  with  facts,  statistics  and  articles  for 
educational  work  of  their  own  in  this  field. 

STATISTICAL  RESEARCH 

A  series  of  special  record  forms  has  been  prepared  for  use  In  various 
hospitals.  A  careful  study  of  facts  about  the  disease  and  the  results 
of  treatment  is  thus  being  made,  and  all  new  knowledge  developed 
thereby  will  be  given  to  the  public. 

The  cooperation  of  the  United  States  Census  Bureau,  state  boards 
of  health  and  individual  physicians  has  been  obtained  in  improving  the 
reporting  and  publication  of  cancer  statistics. 


♦Executive  office,  105  East  22d  St.,  New  York,  N.  Y. 

780 


APPENDIX  H 

Table  3 

Instructions  on  Prevention  of  Cancer,  Issued  by  the  Borough  of 

Portsmouth,  England 


NOTICE  IN  REGARD  TO  CANCER 
Borough  of  Portsmouth 

It  has  been  brought  to  the  notice  of  the  health  committee  that  of  the 
number  of  persons  who  die  each  year  from  cancer  many  could  have  been 
cured  if  they  had  applied  earlier  for  medical  advice.  On  questioning 
patients  as  to  why  they  did  not  apply  to  a  doctor  earlier,  the  reason 
almost  invariably  given  is  that  as  the  early  symptoms  were  unaccom- 
panied by  pain,  it  was  not  thought  that  anything  serious  was  the  matter. 

In  order,  therefore,  to  call  the  attention  of  the  public  to  the  signifi- 
cance of  certain  symptoms  and  conditions,  and  to  the  vital  importance 
of  acting  promptly  on  the  occurrence  of  these,  it  has  been  decided  to 
make  the  following  facts  public : 

The  only  cure  for  cancer,  at  present  known,  is  its  early  and  com- 
plete removal.  Cancer,  if  removed  early,  has  been  proved  conclusively 
to  be  a  curable  disease.  If  neglected,  and  not  removed  in  its  earliest 
stage,  it  is  practically  invariably  fatal.  The  paramount  importance 
of  its  early  recognition  and  early  removal  is,  therefore,  evident.  For 
this  purpose  the  assistance  both  of  the  public  and  the  medical  profession 
is  requisite,  and  a  grave  responsibility  rests  on  both.  It  is  only  by 
their  mutual  co-operation  that  the  ravages  of  this  terrible  disease  can  be 
lessened.  The  following  information  should  be  of  vital  assistance  to 
the  public.  It  is  no  exaggeration  to  say  that,  if  acted  upon,  the  result 
would  be  the  saving  annually  of  many  hundreds  of  lives,  which  at 
present  are  inevitably  lost. 

1.  Cancer,  in  its  early  and  curable  stage,  gives  rise  to  no  pain  or 
symptom  of  ill-health  whatever. 

2.  Nevertheless,  in  its  commonest  situations,  the  signs  of  it  in  its 
early  stage  are  conspicuously  manifest.     To  witness: 

3.  In  case  of  any  swelling  occurring  in  the  breast  of  a  woman  after 
40  years  of  age,  a  medical  man  should  at  once  be  consulted.  A  large 
proportion  of  such  swellings  are  cancer. 

4.  Any  bleeding,  however  trivial,  occurring  after  the  change  of  life 
means  almost  invariably  cancer,  and  cancer  which  is  then  curable.  If 
neglected  till  pain  occurs,  it  means  cancer  which  is  almost  always 
incurable. 

5.  Any  irregular  bleeding  occurring  at  the  change  of  life  should  inva- 
riably be  submitted  to  a  doctor's  investigation.  It  is  not  the  natural 
method  of  the  onset  of  the  change  of  life,  and  in  a  large  number  of 
cases  means  commencing  cancer. 

781 


APPENDIX  H 

Table  3  (concluded) 

Instructions  on  Prevention  of  Cancer,  Issued  by  the  Borough  of 

Portsmouth,  England 

6.  Any  wart  or  sore  occurring  spontaneously  on  the  lower  lip  in  a 
man  over  45  years  of  age  is  almost  certainly  cancer.  If  removed  at 
once  the  cure  is  certain,  if  neglected  the  result  is  inevitably  fatal. 

7.  Any  sore  or  swelling  occurring  on  the  tongue  or  inside  of  the  mouth 
in  a  man  after  45  years  of  age  should  be  submitted  to  investigation 
without  a  moment's  delay,  and  the  decision  at  once  arrived  at  by  an 
expert  microscopical  examination  whether  it  is  cancer  or  not.  A  very 
large  proportion  of  such  sores  or  swellings  occurring  at  this  time  of  life 
are  cancer,  and  if  neglected  for  only  a  few  weeks  the  result  is  almost 
inevitably  fatal.     If  removed  at  once  the  prospect  of  cure  is  good. 

8.  Any  bleeding  occurring  from  the  bowel  after  45  years  of  age, 
commonly  supposed  by  the  public  to  be  "piles,"  should  be  submitted 
to  investigation  at  once.  A  large  proportion  of  such  cases  are  cancer, 
which  at  this  stage  is  perfectly  curable. 

9.  "^^Tien  warts,  moles,  or  other  growths  on  the  skin  are  exposed  to 
constant  irritation  they  should  be  immediately  removed.  A  large 
number  of  them,  if  neglected,  terminate  in  cancer. 

10.  Avoid  irritation  of  the  tongue  and  cheeks  by  broken  jagged  teeth, 
and  of  the  lower  lip  by  clay  pipes.  Many  of  these  irritations,  if  neglected, 
terminate  in  cancer. 

11.  Although  there  is  no  evidence  that  cancer  is  communicable  under 
ordinary  circumstances,  it  is  desirable  that  rooms  occupied  by  a  person 
suffering  from  cancer  should  be  cleaned  and  disinfected  from  time  to 
time. 


A.  Mearns  Feaser,  M.D., 
Medical  Officer  of  Health. 


Health  Department, 

Town  Hall,  Portsmouth. 
January,  1914. 


782 


APPENDIX  H 

Table  4 

Report  on  the  Prevention  of  Cancer  of  the  Medical  Officer  of  Health 

of  the  Borough  of  Shelf,  England 


URBAN  DISTRICT  COUNCIL  OF  SHELF 
Report  of  the  Medical  Officer  of  Health  on  the  Prevention  of  Cancer 

Very  successful  efforts  are  now  being  made  to  reduce  the  general 
death  rate  of  this  country  by  informing  the  public  as  to  the  methods  of 
prevention  of  the  most  fatal  forms  of  disease,  and  thereby  obtaining 
their  assistance.  Until  quite  recently  the  lay  public  were  kept  in 
ignorance— except  through  occasional  and  not  too  accurate  articles  in 
the  public  press — of  the  vital  subject  of  tuberculosis,  but  it  is  now 
realized  that  little  harm  and  very  much  good  has  been  done  by  teaching 
people  how  to  prevent  consumption.  So,  too,  the  prevention  of  cancer 
must  not  be  delayed  because  of  a  few  nervous  persons,  for  it  is  perfectly 
possible  to  state  some  very  important  facts  regarding  cancer  without 
provoking  morbid  self-examination  or  fear. 

The  object  of  this  report,  therefore,  is  to  give  such  facts  in  regard 
to  this  disease,  which,  if  generally  known  and  acted  upon,  would  save 
very  many  lives  annually. 

No  cancer  "parasite"  has  been  found,  and  there  seems  much  evi- 
dence to  support  the  view  that  it  is  a  natural  response  to  injury. 

An  overwhelming  testimony  of  facts  proves  that  the  chief  causative 
influence  in  its  production  is  chronic  irritation,  i.e.,  it  begins  in  a  sore 
place,  perhaps  a  mere  crack,  which  does  not  quite  heal  up  because,  from 
its  position,  it  cannot  be  kept  clean  or  obtain  perfect  rest. 

Prevent  this  chronic  irritation  and  you  will  prevent  cancer ! 

Keeping  in  mind  this  all-important  fact,  the  causation  and  prevention 
of  the  more  common  forms  of  cancer  are  here  considered : 

The  three  more  common  situations  are  the  breast,  the  stomach  and 
the  uterus. 

1.  Breast. — The  evidence  is  very  strongly  in  favour  of  the  cause  be- 
ing chronic  irritation,  the  result  of  repeated  "nursing"  (lactation)  and 
attacks  of  chronic  inflammation  due  to  "cracked  nipples"  which  do 
not  heal. 

Prevention. — Corsets  which  press  the  nipples  inwards  should  be 
avoided,  "cracked  nipples"  completely  cured,  and  a  doctor  consulted 
early  about  any  "lump"  in  the  breast,  whether  this  be  painful  or  not. 
It  may  not  be  by  any  means  necessarily  a  "growth,"  but  it  should  receive 
treatment.' 

2.  Stomach. — About  half  the  cases  of  cancer  of  the  stomach  de- 
velop at  the  seat  of  a  neglected  unhealed  ulcer. 

Prevention. — Very  persistent  chronic  indigestion  should  not  be  neg- 
lected too  long.  Continued  "chronic  irritation"  anywhere  is  unde- 
sirable and  should  be  avoided.     Ulcers   of  the  stomach,   which   are 

783 


APPENDIX  H 

Table  4  (continued) 

Report  on  the  Prevention  of  Cancer  of  the  Medical  OflBcer  of  Health 

of  the  Borough  of  Shelf,  England 

often  due  to  bad  teeth  and  anaemia,  must  be  permanently  cured  and 
not  neglected,  as  is  often  the  case,  for  years. 

3.  Uterus. — Cancer  of  this  organ  is  almost  exclusively  confined  to 
mothers  and  due  to  injuries  at  childbirth,  which  very  simple  remedies 
would  heal. 

Prevention. — Irregular  hemorrhage  at  the  "change  of  life,"  and 
especially — though  slight  and  unassociated  with  pain — occurring  after 
the  "change,"  renders  it  wise  to  consult  a  doctor.  Such  symptoms 
by  no  means  necessarily  imply  cancer,  but  this  disease  can  often  be 
prevented  if  a  medical  man  be  consulted  early  under  these  circumstances. 

4.  Lip. — Its  victims  are  nearly  all  smokers,  its  position  on  the  lower 
lip  and  practically  never  on  the  upper  one.  It  was  very  common  when 
sticky  clay  pipes,  which  readily  became  hot,  were  used,  and  its  cause 
is  chronic  irritation. 

Prevention. — It  is  a  simple  matter  to  see  that  little  cracks  about 
the  lip,  nose  and  ears  are  healed  up. 

5.  Chimney-Sweep's  Cancer. — This,  which  may  occur  in  various  parts 
of  the  body,  is  due  to  constant  irritation  of  soot  and  dust.  Em- 
ployees who  work  at  gas  and  tar  works,  and  who  get  their  clothes 
saturated  with  irritating  substances,  are  also  liable  to  this  disease. 

Prevention. — This  form  of  cancer  is  not  nearly  so  common  now  that 
sweeps  are  cleaner  in  their  habits  and  work.  It  is  wise  to  have  warts, 
moles  and  papillary  growths  occurring  on  any  part  of  the  body  removed. 

6.  Tongue  and  Mouth. — Warty  and  papillary  growths  and  simple 
ulcers  about  the  mouth  are  frequently  due  to  chronic  irritation  from 
smoking,  bad  teeth,  etc. 

Prevention. — When  these  are  present,  sources  of  irritation,  e.g., 
hot  liquids,  alcohol,  smoking,  should  be  avoided.  All  broken  or  jagged 
teeth  should  be  extracted,  and  any  troublesome  sore  investigated. 

7.  Larynx. — The  decrease  in  cancer  of  the  "voice  box"  is  due  to 
the  fact  that  those  conditions  which  contribute  to  their  development 
are  now  recognised  early  and  reheved  by  treatment. 

Prevention. — The  conditions  here  mentioned  are  the  improper  use 
of  the  voice,  the  abuse  of  alcohol  and  tobacco,  and  the  presence  of 
"innocent"  warts. 

8.  Gullet. — Cancer  of  the  "food  pipe"  usually  follows  upon  chroiiic 
irritation  of  simple  ulcers  caused  by  indigestion  or  swallowing  corrosive 
suh)stances  or  hot  liquids. 

Prevention. — Simple  ulcers  should  be  healed  and  hot  liquids  should 
not   be   swallowed. 

784 


APPENDIX  H 

Table  4  (concluded) 

Report  on  the  Prevention  of  Cancer  of  the  Medical  Officer  of  Health 

of  the  Borough  of  Shelf,  England 

9.  Intestine. — Most  of  these  cancers  are  of  the  lower  bowel,  and  no 
doubt  due  to  the  chronic  irritation  of  constipation. 

Prevention. — It  is  wise  to  consult  a  doctor  as  to  any  bleeding  from 
the  bowel  occurring  in  persons  over  45  years  of  age.  Of  course  this 
may  be  due  to  haemorrhoids  ("piles").  Chronic  constipation,  as  well 
as  chronic  diarrhoea,  should  be  cured. 

10.  Gall- Bladder. — The  chief  danger  of  the  long-continued  presence 
of  gallstones  is  the  occurrence  of  cancer  as  an  expression  of  continued 
irritation. 

Prevention. — Persons  who  have  had  gallstone  colic  should  have  the 
gallstones  removed.     This  is  not  at  all  a  serious  operation. 

Cancer,  if  removed  early,  has  been  proved  to  be  a  curable  disease, 
and  the  reason  almost  invariably  given  for  not  having  seen  a  doctor 
earlier  was  that  the  early  symptoms  were  unaccompanied  by  pain. 

Although  cancer  is  probably  not  communicable  under  ordinary  cir- 
cumstances, it  is  desirable  that  rooms  occupied  by  a  person  suffering 
from  cancer  should  be  cleaned  and  disinfected  from  time  to  time. 

J.  AspiNALL  Marsden,  M.O.H., 

Diploma  in  Pvblic  Health. 

Urban  District  Council  Offices,  Shelf. 
July  1,  1914. 


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risks;  Actuarial  Society  of  America, 
New  York,  1903. 

*Fleming,  J.  G.,  Medical  statistics  of  life 
assurance:  being  an  inquiry  into  the 
causes  of  death  among  the  members  of 
the  Scottish  Amicable  Life  Assurance 
Society,  1826-60;  Glasgow,  1862. 

*Florschutz,  G.,  Treatise  on  life  insurance 
medicine;  Berhn,  1914. 

Fox,  R.  H.,  Cancer  as  a  cause  of  death  in 
assured  lives;  Med.  Exam.,  Dec,  1905. 

*Gemiania  (Stettin)  Life  Insurance  Com- 
pany, Mortality  experience  in  certain 
occupations;  Berlin,  1882. 

*Germania  (Stettin)  Life  Insurance  Com- 
pany, Investigations  into  mortality 
experience  of;  Berlin,  1897. 

Gollmer,  R.,  Causes  of  death  among  the 
insured  of  the  Gotha  Life  Insurance 
Company,  1829-96;  Publication  of 
German  Society  for  Insurance  Science, 
Berlin,  1906. 

*Gotha  Life  Insurance  Company,  Ex- 
perience of;  Jena,  1902. 

*Greene,  C.  L.,  Medical  examination  for 
life  insurance;  Philadelphia,  1905. 

*Hall,  F.  DeH.,  Treatise  on  medical  ex- 
amination for  life  assurance;  Bristol, 
1906,  3d  edit.,  p.  12. 

Hesse,  Arthur,  Analysis  of  the  mortality  of 
the  Basel  Life  Insurance  Company; 
Leipzig,  1899,  p.  22. 

Hoffman,  Frederick  L.,  Educational  value 
of  cancer  statistics  to  insurance  com- 
panies; Surg.,  Gijn.  and  Ohst.,  June, 
1914,  pp.  726-730. 
Research  work  in  life  insurance  medicine; 
Med.  Rec,  Sept.  7.,  1912. 

*Holden,  E.,  Observations  on  an  attempt  to 
utilize  the  experience  of  twenty-one 
years;  Newark,  1868. 


804 


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Holovitchiner,  E.,  Observations  regarding 
theory  and  facts  as  to  the  origin  ot" 
cancer  and  its  bearing  upon  life  insur- 
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Hyde,  James  Nevins,  Life  expectancy  in 
syphilitics;  Med.  Exam.,  Apr.,  1898. 

Juliusburger,  P.,  Mortality  from  cancer  in 
experience  of  Friedrich-Wilhelm  In- 
surance Company,  1885-99;  Ztschr.  /. 
Krebsf.,  1905,  iii,  106. 

*Levan,  J.  R.,  Treatise  on  medical  ex- 
amination for  life  insurance;  Philadel- 
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*  Medico- Actuarial  Mortality  Investiga- 
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Directors  and  the  Actuarial  Society  of 
America,  1912-14,  5  vols. 

Meiji  Life  Assurance  Company,  Mortality 
experience  of,  1899-1907;  Tokio,  Japan. 

*Meikle,  James,  Observations  on  the  rate 
of  mortality  of  assured  lives  as  ex- 
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*Metropolitan  Life  Assurance  Society, 
Mortality  experience  of,  1835-64;  Lon- 
don, 1865. 

Millman,  T.,  Transmission  of  predisposi- 
tion to  cancer  and  its  importance  in 
life  insurance;  Med.  Exam.,  Jan.,  1897. 

*Moinet,  F.  W.,  Guide  to  medical  examina- 
tion for  life  insurance;  Edinburgh, 
1876,  pp.  30-34. 

*Mutual  Life  Insurance  Company  of  New 
York,  Mortahty  statistics  of,  1843-74; 
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*Catalogue  descriptive  of  charts,  dia- 
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position, 1900. 

^Mortahty  statistics  of,  1843-98;  New 
York,  1900. 

*Mortuary  experience  of,  reports  and 
analysis  by  Messrs.  Winston,  Gillette 
and  Marsh;  New  York,  1877,  vol.  ii. 

Oliver,  Sir  Thomas,  Medico-social  prob- 
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Payne,  J.  F.,  Relation  of  cancer  to  life  as- 
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1898. 


*Pollock,  J.  E.,  and  Chisholm,  James, 
Medical  handbook  of  life  assurance  for 
the  use  of  medical  and  other  officers  of 
companies;  London,  1897,  4th  edit. 

*Prudential  Assurance  Company,  Industrial 
experience  of,   with  appendix,  by  H. 
Harben,  1864-66;  London,  18G7. 
*Industrial     mortality     experience     of, 
1867-70;  London,  1871. 

*Ramsey,  M.  E.,  Practical  life  insurance 
examinations;  Philadelphia  and  Lon- 
don, 1908. 

Richardson,  J.  H.,  Observations  on  the  as- 
sessment of  life  risks  where  there  is  a 
predisposition  to  phthisis  or  cancer; 
WelUngton,  N.  Z.,  1899. 

*Richter,  Karl,  Handbook  of  medical  ex- 
aminers for  life  insurance;  Leipzig, 
1899. 

*Ring,  Frank,  Observations  on  how  to  ex- 
amine for  life  insurance;  St.  Louis, 
1901,  pp.  29,  96. 

*Scottish  Amicable  Life  Assurance  Society, 
Mortality  experience  of,  1826-60; 
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*Sieveking,  E.  H.,  Medical  adviser  in  life 
assurance;  London,  1874. 

*Smee,  A.  H.,  Causes  of  death  in  the  ex- 
perience of  Gresham  Life  Assurance 
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*Stillman,  C.  F.,  The  life  insurance  ex- 
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1890,  3d  edit.,  p.  101. 

*Stuttgart  Life  Insurance  Company,  Mor- 
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*Symonds,  Brandreth,  Life  insurance  ex- 
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1905,  pp.  69-71,  81,  88. 

*Thompson,  E.  E.,  Different  aspects  of 
family  phthisis,  in  relation  to  heredity 
and  life  assurance;  London,  1884. 

*Thorburn,  James,  Manual  of  life  insurance 
examinations;  Toronto,  1887,  p.  9. 

*Washington  Life  Insurance  Company, 
Historical,  actuarial  and  medical 
statistics  of;  New  York,  1889,  p.  151. 

Whitmore,  H.  W.,  Cancer  in  the  family 
history;  Med.  Exam.,  Feb.,  1907. 


805 


INDEX    OF    AUTHORS 


Abrahams,  Adolphe,  4 
Adami,  J.  G.,  202,  205 
Allen,  J.  A.,  78 
Andrews,  E.,  41 
Arlidge,  J.  T.,  58,  62 
Arnstein,  Alfred,  68,  69 
Atlee,  Miss  E.,  154 
Atwater,  W.  O.,  777 
Auerbach,  E.,  149 

Bainbridgb,  William   Seaman,   41,   128, 

150, 184,  210 
Baker,  B.  E.,  67 
Banks,  Mitchell,  22 
Bashford,  E.  F.,  3,  14,  17,  18,  25,  27,  34,  35, 

36,  41,  42,  43,  44,  131,  153,  172,  199, 

200,  283 
Bazin,  E.,  190 
Beatson,  Sir  George  T.,  204 
Begbie,  James,  79,  80,  82 
Behla,  R.,  197,  203 
Bell,  Benjamin,  6,  22 
Beneke,  F.  W.,  190 
Berchelmann,  Johann  Philip,  174 
Bertillon,  Jacques,  73,  276-282 
Blancard,  Stephen,  22 
Bland-Sutton,  J.,  156 
Bloodgood,  Joseph  C,  155, 171,  213,  215 
Boas,  Franz,  183, 193 
Boldt,  H.  J.,  214 
Borrel,  A.,  205 
Borst,  Max,  4 
Braithwaite,  J.,  148 
Branthwaite,  R.  W.,  189 
Brinton,  W.,  78 
Brockbank,E.M.,  79 
Bryan,  W.  A.,  215 
Buday,  K.,  160 
Bulkley,  L.  D.,  174, 178 
Butlin,  Sir  H.  T.,  51 

Cabot,  Richard  C,  4 

Cahen,  M.,  188 

Celsus,  Aurelius  Cornelius,  5 

de  Chauliac,  Guy,  187 

Childe,  Chas.  F.,  57,  164,  185,  190,  196,  215 

Chittenden,  Russell  H.,  175,  178, 179,  777 

Clemow,  F.  G.,  105 

Clouston,  T.  S.,  208 

Cohnheim,  Julius,  6,  60,  202,  205 

Coley,  Wm.  B.,  22, 139 

Corbin,  E.  E.  L.,  4 

Corson-White,  Ellen  P.,  176 

Couch,  Louis  Bradford,  186 

Crile,  G.  W.,  207 


Cripps,  W.  Harrison,  172 
Cropper,  J.  W.,  69 
CuUen,  Thomas  S.,  157-158 
Curie,  Mme.,  211 
V.  Czemey,  V.,  213 

Davidson,  Andrew,  105 

Degrais,  Paul  (see  Wickham  and  Degrais) 

Delafield,  Francis,  8,  9, 10  (see  Delafield  and 

Prudden) 
Delafield  and  Prudden,  9,  10,  25, 167, 198 
Dennis,  Frederick  S.,  128 
Dollinger,  JuHus,  151,  315 
Dore,  S.  E.,  211 
Dublin,  Louis,  4 
Duhrssen,  Alfred,  213,  214 
Dunn,  H.  P.,  24, 174 

Emerson,  C.  P.,  170 

V.  Esmarch,  F.,  190 

d'Etiolies,  Leroy,  189 

Ewing,  James,  43, 158,  297,  299,  301,  303 

Fabre,  Pierre,  189 

Farr,  William,  29,  104 

Fenwick,  P.  C.  (see  Hislop  and  Fenwick) 

Fishberg,  Maurice,  148,  149 

Forrest,  E.  D.,  208 

Fox,  H.,  34 

Fraser,  A.  Meams,  216,  782 

French,  Herbert,  5,  22, 170, 183 

Frerichs,  F.  T.,  193 

Frief,  F.,  206 

Gairdner,  W.  T.,  81 

Galen,  Claudius,  5,  6 

Gastpar,  76 

Gavales,  S.  A.,  699 

Gaylord,  H.  R.,  121,  180, 181, 203  (see  Gay- 

1  ord  and  Marsh) 
Gaylord  and  Marsh,  181 
Gilford,  Hastings,  4, 14, 153, 168, 184, 193 
Gould,  Sir  Alfred  Pearce,  184 
Gould,  G.  M.  (see  Gould  and  Pyle) 
Gould  and  Pyle,  11,  34, 180, 192,  273 
Goupil,  188 

Green,  C.  E.,  63, 64,  65,  66, 152, 197, 198, 777 
Greene,  Charles  Lyman,  78 
Greenough,  Robert  B.,  215 
Greer,  W.  J.,  59 
Greischer,  S.,  658 

Grotjahn,  Alfred  (see  Grotjahn  and  Kaup) 
Grotjahn  and  Kaup,  16 
Gryzanovski,  E.  G.  F.,  3 
Gunsburg,  B.  F.,  174 


807 


INDEX  OF  AUTHORS 


Haaland,  M.,  153 

Hall,  Haviland,  79 

V.  Hansemann,  D.,  205 

Harben,  Henry,  90 

Harris,  Philander  A.,  213 

Harris,  W.  H.,  188 

Harting,F.H.,68 

Hartwell,  John  A.,  165 

Hatch,  J.  Leffingwell,  9,  271 

Hauser  P.   694 

Haviland,  Alfred,  104,  105, 191, 199 

Hazen,  H.  H..  215 

Heim,  Gustav,  73 

Heron,  David,  57, 184, 189,  190 

Hesse,  W.,  68 

Hill,  Bertram,  15 

Hippocrates,  5,  207 

Hirsch,  August,  104, 105 

Hirschberg,  58 

Hislop  P.  W.  (see  Hislop  and  Fenwick) 

Hislop  and  Fenwick,  190,  204-205 

Hoeber,  W.  R.,  202 

Hoffman,  Frederick  L.,  3,  15,  25,  46,  47,  86. 

103,  125,  131,  151,  162,  163,  166,  185, 

187, 777 
Hollander,  Bernard,  208 
Horand,  M.,  189 
Horsley,  Sir  Victor,  184 
Hrdlicka,  Ales,  152 
Hunter,  Arthur,  360 
Hunter,  John,  187 
Hutchinson,  Sir  Jonathan,  4, 14 

Jacobson,  J.  H.,  213 
Jaquith,  W.  A.,  86 
Jevons,  Stanley,  73 
Judd,  E.  S.,  164 

Kappeler,  O.,  193 

Kaup,  J.  (see  Grotjahn  and  Kaup) 

Keen,W.W.,  155 

Kelly,  Howard  A.,  194 

King,  George,  34  (see  King  and  Newsholme) 

King  and  Newsholme,  18,  28,  30,  31,  33,  34, 

46,  83,  84,  90, 105,  283 
Kirschner,H.,  148 
Knopf  el,  L.,  149 
Kolb,  Karl,  76,  644-645 

Lakeman,  Curtis  E.,  215 

Lambe,  Howard,  174 

Landis,  H.  R.  M..  188 

Laurence,  J.  Z.,  153 

Lawes,  E.  T.  H.,  50 

Lazarus-Bariow,  W.  S.,67, 185-186,  202,  205 

Le  Conte,  John.  7,  22,  23 

Lenhart,  C.  H.,  181 

Leonard,  C.  L.,  67 

Leonidis,  5 

Leuenberger,  S.  G.,  68 

Levin,  Isaac,  151,  210 

Lex,  160 

Leyden,  Hans,  693 


Lichty,  J,  A.,194 
Lindemann,  E.,  650-651 
Lockwood.  C.  B.,  7, 169 
Lombroso,  Cesare,  148 
Longstaff,  G.  B.,  2,  3,  24,  206 
Lyon,  Glover,  34 
Lyon,  LP.,  105,  201 

MacCartht,  195 

Madden,  F.  W.,  136 

Magruder,  W.  E.,  60 

Mallory,  F.  B..  166 

Marine.  David,  181 

Marsden,  J.  A.,  785 

Marsh,  M.  C.  (see  Gay  lord  and  Marsh) 

Martin,  213 

Martin,  Franklin  H..  215 

Matas.  Rudolph,  128, 132,  531 

Maudsley,  Henry.  208 

Maydl  (see  Maydl  and  Nothnagel) 

Maydl  and  Nothnagel.  194 

Maynard.  G.  D.,  192 

Mayo,  C.  H.,  195 

Mayo,  W.  J.,  187,  210 

McCarrison,  Robert,  180-181 

McGraw,  T.  A.,  213 

Meech,  357 

Meitzen,  August,  3 

Menard,  66 

Mendel,  Lafayette  B.,  176 

Mercier,  Charles,  208 

Meyer,  Willy,  207,  214 

Michel,  174 

Mill,  John  Stuart,  73 

Miller,  James,  155, 156 

Mitchell,  58 

Moinet,  F.  W.,  78 

Montgomery,  E.  E.,  169 

Moore,  C.  H.,  154 

Morison,  Rutherford,  189-190 

Morris,  Sir  Malcolm,  211 

Moullin,  C.  M.,  155, 167 

Muirhead,  Claud,  84 

Murray,  J.  A.,  34, 173 

Murray,  R.  W.,  36 

Neve,  Ernest  F.,  30 

Neves,  A.,  696 

Newsholme,  Arthur,  34,  173  (see  King 

and  Newsholme) 
v.  Noorden,  Cari,  176,  191 
Nothnagel  (see  Maydl  and  Nothnagel) 

Oertel,  H.,  4 

Ogle,  Wilham,  86,  87,  172 

Ogston,  58 

Oliver,  Sir  Thomas,  49,  59,  64,  66, 198,  201 

Orth,  J.,  160 

Osborne,  Thomas  B.,  176 

Otto,  C,  165 

Paget,  Sir  James,  4, 14,  78,  91 
Park,  Roswell,  41 
Parker,  Willard,  92 


808 


INDEX  OF  AUTHORS 


Parsons,  C.  L.,  212 

Payne,  J.  ¥.,  34,  84, 

Pearson,  John,  C,  21,  73 

Pearson,  Karl,  172 

Penibrey  (see  Pembrey  and  Ritchie) 

Perabrey  and  Ritchie,  4,  8,  2C9 

Phelps,  E.  B.,  4 

Pinch,  A.  E.  H.,  210 

Pitchford,  W.  W.,  68 

Poirier,  Paul,  18S) 

Poppelmann,  VV'alther,  204 

Porter,  C.  A.,  66 

Powers,  D'Arcy,  200 

Prinzing,  Fr.,  104 

Prudden,  T.  M.  (see  Delafield  and  Prudden) 

Pyle,  W.  L.  (see  Gould  and  Pyle) 

quetelet,  n.  a.,  3 

Rabagliati,  a.,  183 

Ramazzini,  Bern.,  48 

Rambousek,  J.,  58 

Ramsey,  M.  E.,  79 

Recamier,  J.  A.  C,  190 

Rehn,  Ludwig,  59 

Reick,  H.,  160 

Reick,  J.,  160 

Renner,  W.,  36, 137 

Repin,  180 

Reyburn,  Robert,  41. 183, 184 

Ribbert,  H.,  205 

Richardson,  J.  H.,  34 

Ritchie,    James,    168    (see    Pembrey  and 

Ritchie) 
Robertson,  W.  F.  203 
Rodman,  W.  L.,  155,  207,  213 
Rogers,  Leonard,  4, 138, 177 
Rogers,  S.  L.,  304 
Rokitansky,  188 
Romer,  P.,  47,  208,  209 
Roncali,  D.  B.,  207 
Ross,  F.  W.  F.,  179 
Ross,  H.  C,  69 
Rous,  Peyton,  176 
Rumsey,  H.  W.,  3 
Russell,  Rollo,  57,  58,  215 

Sampson,  J.  A.,  215 

Sargant,  W.  L.,  23,  24 

Sato,  K.,  139 

Savill,  T.  D.,  169, 170, 171, 192 

Saxon,  G.  J.,  176 

Schamberg,  J.  F.,  54 

Schmidt,  Rudolph,  4,  154,  165,  171,  188, 

190, 194 
Schwarz,  I.,  29 
Seyberth,  Ludwig,  59 
Sharp,  Samuel,  6 
Shaw,  H.  B.,  4 
Sibley,  78,  92 
Sieveking,E.H.,  78 


Simmonds,  M.,  44 
Slye,  Miss  Maud.  173 
Smith,  A.  W.,  206 
Snow,  Herbert,  184 
Soegaard,  Munch,  203 
Steinhaus  J.    160 
Steinhelm,  149 
Sweet,  J.  E.,  176 
Symonds,  Brandreth,  359 
Syms,  Parker,  155,  156,  157,  214 

Tanchou,  M.,  23 
Tatham,  J.  F.,  34,  49,  86,  87 
Taussig,  F.  J.,  214 
Teece,  Richard,  34 
Thackrah,  C.  T.,  48 
Theilhaber,  A.,  658 
Theilhaber,  Felix.  149,  688 
Thompson,  W.  G.,  61 
Tyzzer,  E.  E.,  173 

Van  der  Velden,  176 
Van  Konijnenburg,  J.  J.,  150 
Vaughan,  J.  W.,  207 
Velpeau,  Alfred,  78 
Verworn,  Max,  73,  74 
Vigouroux,  Romain,  190 
Virchow,  Rudolf,  6,  73,  202,  205 

Wade,  H.,  203 

Wainwright,  J.  M.,  165 

Walshe,  W.  H.,  6,  7,  29,  266 

Ward,  78 

Warren.  J.  M..  6,  7 

Watkins-Pitchford,  Wilfred.  204 

Webb,  Law.,  199 

Weinberg,  W.,  76,  205 

Werner,  R.,  73,  203-204 

Wertheim,  Ernst,  210 

Weyl,  Theodor,  62 

White.  C.  P.,  7, 10. 11,  70, 155, 196,  272 

White,  G.  D.,  205 

White,  R.  P.,  55 

Wickham,     Louis     (see     Wickham     and 

Degrais) 
Wickliam  and  Degrais,  211 
Willcox,  W.  F.,  31. 46.  47. 105 
Williams,  W.  Roger.  11.  14,  15.  41,  55,  56, 

57,  60.  90, 105, 136, 150,  154,  165,  174, 

175,  177,  185,  188,  190,  192,  193,  206 
Williamson,  C.  S.,  170 
Winkler,  195 

Winter,  Georg,  212.  213.  214 
Winternitz,  M.  C,  86 
Woglom,  W.  H.,  5 
Wolfif,  Jacob,  6.  16.  26.  54.  62.  97.  128.  140. 

148.  174,  179,  187,  188.  189,  190,  195, 

198,  213 
Wright,  E.  F.,  179 

Young,  H.  H.,  215 


809 


INDEX   OF    SUBJECTS 


Abdomen,  cancer  of,  147 
Abdominal  viscera,  tumors  of,  5 
Aberdeen,  Scotland,  C15 
Abscesses,  mortality  from,  37 
Accessible  cancers,  mortality  from,  30,  31, 
33,  37,  84 
classification  of,  283 
Accidents  and  cancer,  48,  49,  440-441  (see 

traumatism  and  irritation) 
Accuracy  of  statistics  (see  statistics) 
Actinic  stimulation  and  cancer,  68,  204 
Actuarial  statistics,  35,  83-84 
Adami,  theory  of  growth  of,  202 
Adenoma,  10,  273 

Advertisements  of  alleged  cancer  cures,  212 
Africa,  106,  136-137,  219,  702 
Africans,  cancer  among,  36,  137,  704  (see 

Creoles  and  negroes) 
Age,  in  relation  to  cancer,  11-14,  24,  34,  85, 
88,  89,  93,  94,  102,  109,  111-114, 
116-120,  131,  152,  169,  199,  200, 
201,  305-401,  418-785 
average,  at  death,  77,  85,  88,  89,  201 
and  cancer  increase,  111,112 
in  carcinoma  and  sarcoma,  14, 131 
and  conjugal  condition,  100 
distribution,  changes  in,  39 
incidence,  by  organs  and  parts  and 

sex,  113-114,  228-231,  316-785 
of  inmates  of  cancer-houses,  198-199 
international  statistics  according  to, 

238-261 
old,  extreme,  14,  38,  77,  109,  114,  134, 

135,  153,  154,  183,  204 

and  sex,  effect  of,  12,  111-112,  114-115 
specific  death  rates  according  to,  436- 

439 
standardization  of  rates  for,  12,  114 
Agricultural  workers,  57,  58,  62,  72,  74,  75, 

204,  306-313,  315 
Albuminoid  diet  and  cancer,  174, 175 
Alcohol  and  cancer,  57,  116-121,  174,  183, 

184, 220 
Alcohol  and  cancer  of  oesophagus,  183 
Algeria,  cancer  mortality  of  Europeans  in, 

136,  702 
Alsace-Lorraine,  650 

America,  geographical  distribution  of  can- 
cer   in,    106,    740    (see    Western 
Hemisphere) 
cancer  in  cities  of,  145,  225,  473 
mortality  statistics  of,  improvement  of, 

4,  44 
vital  statistics  of,  4,  34,  42,  44 
American  Gynecological  Society,  777 


American  Medical  Association,  215 
American  Oncologic  Hospital,  159 
American  Society  for  the  Control  of  Cancer, 

777,  779 
Amsterdam,  Holland,  40, 106,  662-665 
Anaemia,  clinical  significance  of,  170, 176-177 
Anaplasia,  theory  of  cancer,  205 
Angioma,  10,  273 
Angola,  706 

Aniline-dye  workers,  59,  70,  73 
Animals,  cancer  in,  63,  152,  173-174,  181- 

182,  207 
Antagonism,  theory  of  cancer,  188 
Anthracene  and  cancer,  49-51,  61 
Anthropometry  of  cancer  patients,  97-98, 

356  (see  height  and  weight) 
Antiquity  of  cancer,  5 
Antwerp,  Belgium,  669 
Apoplexy,  mortality  from,  440-441 
Appendicitis  and  cancer,  36,  117-121,  194- 

195,  220 
operations  for,  195 
Arabs,  cancer  among,  136 
Arctic  regions,  142  (see  latitude) 
Argentina,  40,  140-141 
Arid  regions,  cancer  in,  192 
Armenians,  cancer  among,  701 
Arsenic  workers,  56, 70 
Arthritism  and  cancer,  190 
Asia,  106, 137, 138,  219,  708 
Asiatics,  cancer  among,  704 
Asylums,  cancer  among  inmates  of,  58 
Athens,  Greece,  700 
Atra  bilis,  theory  of  cancer,  179 
Augsburg,  Germany,  202 
Augusta,  Georgia,  128,  475-476 
Australasia,  106,  107,  138,  720 
Australian   Commonwealth,    12,     38,     39, 

107,    123,    124,    125,    139,    193, 

254-255,  412,  720-722 
mortality  from  diabetes  in,  193 
Austria,  38,  40, 107, 134, 135,  679,  680 
Autopsy  investigation,      Johns      Hopkins 

Hospital,  86 
Autopsy  records,  4,  18,  23,  81,  84,  86,  138, 

156,  160,  164,  170,  177,  194,  288- 

289 
Average  age  (see  age) 
Ayr.  Scotland,  200 

Bacteria  and  cancer,  198 
Baden, 648-649 

cancer  census  of,  36,  185,  203,  204, 206 
Bahia,  Brazil,  141,  764-765 
Bakers,  48,  306-313 


811 


INDEX  OF  SUBJECTS 


Baltimore,  Maryland.  128,  477-479 
Barbados,  hospital  statistics  of,  751 
Barbers,  314 
Barnard  Free  Skin  and  Cancer  Hospital, 

159 
Bartenders,  314 
Basel,  Switzerland,  678 
Bashford,  cancer  classification  of,  31 
Bavaria,  33, 123, 124, 125, 136, 219,  246-247. 

412,  643-646 
Belfast,  Ireland,  625 
Belgium,  134,  667-668 
Bell,  on  ulcers,  6 
Bellevue  Hospital,  20 
Bello  Horizonte,  Brazil,  767 
Bengal,  India,  709 
Benign  tumors  (see  tumors) 
Berbers,  cancer  among,  136 
Bergen,  Norway,  634 
Berlin,  Germany,  653-654 
Bermuda,  139-141, 747 
Bern,  Switzerland,  678 
Bertillon  classification  of  deaths  from  can- 
cer and  other  tumors,  73,  276-282 
Betel-nut  chewing  and  cancer,  15,  30,  122, 

138, 147 
Bile  and  cancer,  179 
Biliary  calculi,  38, 110,  281,  430 
Biochemical  aspects  of  cancer,  179,  197 
Biological  aspects  of  cancer    4,  6,  9,  198, 

203 
Birmingham,  England,  610 
Blacksmiths.  57, 313, 316 
Bladder,  cancer  of,  59, 70, 116, 120 
Blast-furnace  workers,  61 
Blastomycetes  in  plants,  198,  207 
Bloo.d,  changes  of,  176 
Blood  disease,  cancer  not  a,  171 
Boatmen,  314 
Bogota,  Colombia.  760 
Bohemians,  cancer  among,  680 
Bolivia,  140-141 
Bookbinders,  313 
Bordeaux,  France,  672 
Boston,  Massachusetts,  39,  128.  129,  130, 
479-483 
early  cancer  records  of,  7 
Boxmakers,  313 
Bradshaw  Lectures,  184 
Brazil,  39. 139-141 

Breast,  cancer  of,  5,  7,  37,  58,  68,  77,  100. 
110,  114,  115,  116,  120,  122-125, 
130,  139,  168,  179,  191,  210,  229, 
231,  300-301,  316-775 
average  age  at  death,  169 
in  Ceylon,  138 

and  conjugal  condition,  98,  99, 100 
diagnosis  of,  5,  6,  111,  158 
duration  of,  165-166 
hospital  experience  of,  159, 163 
among  Japanese  women,  125,  220 
among  Jewesses,  148, 149 
recurrence  in,  165 


Bremen,  Germany,  652 

Brewers,  57.  64,  72,  73,  306-313  (see  malt- 
sters) 

Briquette  manufacture,  61 

Bristol,  England,  611 

British  Columbia,  39, 745 

British  Guiana,  140-141, 752-753  ) 

British  Honduras,  140-141, 751 

British  possessions,  42 

British  ^'est  Indies,  140-141  _ 

Brompton  Free  Cancer  Hospital,  159 

Brookfield  Township,  New  York,  105, 201- 
202 

Brooklyn,  New  York,  128, 484-485 

Brussels,  Belgium,  160,  669 

Buccal  cavity,  cancer  of,  77,  110,  111,  113, 
114,  115,  130,  132,  139,  158,  163, 
298-299,  316-775 
model  inquiry  blank  for,  298-299 
and  smolang.  185-186 

Budapest,  Hungary,  148-150,  686-688 

Buenos  Aires,  Argentina,  141, 767-770 

Buffalo,  New  York,  128, 484 

Build  and  cancer,  97-98  (see  anthropome- 
try, height  and  weight) 

Builders  and  contractors,  313 

Burghers  in  Ceylon,  cancer  among,  710 

Butchers,  57,  71,  75,  306-315 

Cachexia,  clinical  significance  of,  45, 170 
Calculi  of  urinary  tract,  38,  281,  430 
Calcutta.  India,  137-138, 708 

autopsy  records  of,  177 
California,  108, 422 

Campaign  against  cancer   (see  American 
Society  for  Control  of  Cancer  and 
education) 
Canada,  140 

Cancer  a  deux,  195,  205-206 
Cancer,  age  in  relation  to  (see  age) 

antiquity  of,  5 

areas.  199,  201,  202,  204,  220 

blanks,  model,  284-304 

cages,  200 

carriers,  205 

census,  35,  36 

classification  (see  classification) 

comparative  mortality  from  other 
causes  and,  440-441 

conjugal  condition  as  a  factor  in,  97- 
101,  205,  219,  603,  604  (see  mar- 
ital infection) 

cures,  alleged,  212 

deaths,  transfer  of,  113 

definition  of,  4,  7, 18,  30, 155 

and  diabetes,  192 

diagnosis,  difficulties  of,  5 

duration  of  (see  duration) 

education,  777-783 

families,  202-204 

fear,  208 

hospital  statistics,  158-161 

houses.  196,  198-201,  220 


812 


INDEX  OF  SUBJECTS 


Cancer  (continwd) 

importance  to  insurance  companies  of, 

77-lOa 
increase   of,    details    hy    organs   and 
parts,  age,  and  s("x,  38   (see  in- 
crease and  mortality) 
Kangri,  of  Kashmir  (see  Kanori) 
latitude  as  a  factor  in  (see  liititudc) 
mortality,  earliest  statistics  of,  23 
occupational  incidence  of  (see  occupa- 
tion) 
patients,  physical  condition  of,    153- 
155    (see   anthropometry,    height 
and  weight  records,  model  forms 
for) 
race  as  a  factor  in  (see  race) 
records,    inquiry    blanks    and    forms, 

284-304 
rooms,  198 

sex  as  a  factor  in  (see  sex) 
streets,  197-202 
terminology,  difficulties  of,  4 
and  tuberculosis  (see  tuberculosis) 
varieties  of,    167    (see  definition   and 

classification) 
villages,  197,  199-204,  220 
Canvassers  and  collectors,  314 
Cape  Colony,  136,  704 
Cape  Verde  Islands,  706 
Carcinoma,  definition  of,  5,  9,  10,  14,  34, 
273  (see  classification) 
and  sarcoma,  mortality  from,  167 
Carcinomata,  duration  of,  167 

subclassification  of,  11 
Carpenters  and  joiners,  306-313,  315 
Causation,   30,    72,   73,   74,  116-121,  141, 
168-169,    220    (see  irritation   and 
parasitic  theory) 
Causes  of  death,    contributory  in   cancer 

patients,  44-45,  164 
Cellular  pathology,  4,   6,   184   (see  Cohn- 

heim's  theory) 
Celsus,  knowledge  of  cancer  of,  5 
Census,  cancer,  35 

observations  on,  74,  75,  76, 185,  186 
Baden,  36,  203,  204,  206 
Germany,  40,  74-75 
Holland,  40 
Hungary,  71,  206,  315 
Sweden,  76 
Census,  letter  from  director  of,  304 
Centenarians,  14  (see  old  age) 
Certificate  of  death,  standardized,  285 
Cervical  erosion  and  cancer,  157 
Cervix,  cancer  of,  99 
Cestodes,  205 
Ceylon,  15, 137,  138, 147,  709-711 

cancer  of  breast  in,  138 
Chance  occurrence  of  cancer,  206 
Channel  Islands,  134, 135,  627 
Charity  Hospital,  New  Orleans,  132,  158, 
159,526-531 


Charleston,  South  Carolina,   16,   128,  129, 

487-489 
Charts,  cancer  mortality,  224-265 

Age   and    organs   and    parts.    United 

States  Registration  Area,  230 
Australia,  254 
Bavaria,  246 
Cities,    comparative,    American    and 

foreign,  226 
England  and  Wales,  240 
Fatality  rate,  Johns  Hopkins  Hospital, 

264 
Holland,  244 

International  statistics,  224,  228 
Ireland,  242 
Italy,  250 
Japan, 252 
London, 260 
New  York  City,  258 
Organs  and  parts,  international  statis- 
tics, 228 
Prudential  Industrial  experience,  262 
Race,  eight  Southern  cities,  U.  S.,  234 
Race,  Maryland,  236 
Sex  and  age.  United  States  Registra- 
tion States,  232 
Switzerland,  248 
United  States,  Registration  Area,  230, 

232,  238 
Uruguay, 256 
Chauffeurs,  314 
Cheek,  cancer  of,  15,  30, 122, 147  (see  buccal 

cavity,  Kangri  cancer) 
Chemical  industries,  58,  62,  65,  66 
Chicago,  Illinois,  128, 490-492 
Childbirth  and  cancer,  116-121, 135 
Childhood,  cancer  in,  183 
Chile,  140-141,  772 

Chimney-sweeps'    cancer,    49-51,    56,    57, 

58,    59,   60,   61,   62,   63,   64,   69, 

70,    72,    73,    122,   147,    175,   176, 

306-312 

China,  178,  714-715 

Chinese,  cancer  among,  36,  138,  139,  178, 

714-715,719 
Chloroma,  273 
Cholesteatoma,  273 
Chondroma,  definition  of,  9, 10,  273 
Christiania,  Norway,  633 
Christians  and  Jews,  cancer  among,  650, 

658  (see  Jews) 
Chronic  irritation  and  cancer,  183-187  (see 
irritation,    alcoholism,    smoking, 
etc.) 
Chronometry  of  life,  14 
Cider-drinking  and  cancer,  58, 174 
Cigarmakers,  57  (see  tobacconists) 
Cincinnati,  Ohio,  128,  492-493 
Cirrhosis,  hepatic,  183 

Cities,  cancer    in,   126-129,    144-145,   227, 
402-775 
cancer  mortality  in,  by  size,  144 
increase  in  cancer  mortality  of,  127-128 


813 


INDEX  OF  SUBJECTS 


Civilization  and  cancer,  23,  122,  146,  147, 

178 
Ci^^lized•  world,  mortality  in,  38,  39-41,  221 
Classification,   Bertillon,  international,  of 
tumors    and    diseases    allied    to 
tumors,  276-282 
International,  of  causes  of  death,  31 
of  plant  parasites,  198 
of  tumors,  8,  9,  10,  11,  22,  167,  268-283 
Classification  of  cancer,  7-11;  18-20,  22-23, 
25,  31,   105,   155,  161,  167,  268- 
283 
changes  in,  37 

clinical  and  anatomical,  155,  166,  167 
Delafield,  8 

Delafield  and  Prudden,  9, 10 
Gould  and  Pyle,  273-275 
Hatch,  9,  271 

Imperial  Cancer  Research  Fund,  283 
Pembrey  and  Ritchie,  8-9,  269-270 
Walshe,  7,  268 
"\Miite,  10-11,  272 
Clay-pipe  smoking  and  cancer,  59, 185 
Clergj-men,  71,  72,  306-312,  314 
Clerks,  bookkeepers,  etc.,  314 
Cleveland,  Ohio,  128, 494-496 
CHmate,  143, 152,  204 
Clinical  diagnosis,  169-170 

records  of,  value  of,  171  (see  classifica- 
tion, clinical) 
Coachmen,  57 

and  chauffeurs,  314 
Coal-dealers,  72,  306-312,  314 
Coal-heavers,  57 
Coal-miners,  57,  306-313 
Coal-soot  (see  soot  and  chimney-sweeps' 

cancer) 
Coal-tar  industry  (see  tar  and  paraffin  in- 

dustrj') 
Cobalt-mine  workers,  70 
Coexisting    diseases    (see    coincident    dis- 
eases) 
CoflFee-drinking  and  cancer,  178 
Cohnheim,  cancer  theory  of,  6,  60,  202 
Coincidence,  significance  of,  171,  191,  199, 

201,  204-206 
Coincident  diseases,  187-188,  220  (see  dia- 
betes, sj'philis,  tuberculosis,  etc.) 
Collective   phenomena    (see   law   of   large 

nimabers) 
Colloid  cancer,  definition  of,  8 
classification  of,  268,  273 
Cologne,  Germany,  656 
Colombia,  United  States  of,  140 
Colorado,  108,  422 
Columbus,  Ohio,  128,  496 
Commerce  (employers  and  employees),  315 
Commercial  travelers,  57 
Common  laborers,  315 
Commonwealth  of  Australia  (see  Australian 

Commonwealth) 
Communicability  of  malignant  disease,  206 
(see  infection) 


Comparative    mortality,     American     and 

foreign  cities,  145,  226 
international,  413-417 
by  race,  234 

Western  Hemisphere,  139-141 
Complications  in  cancer,  44-46 
Conclusions,  restatement  of,  218-221 
Conditioning  circumstances  (see  causation) 
Conjugal  cancer,  203,  207 
Conjual  condition  and  cancer,  97-101,  205, 

220,  603-604   (see  marital   infec- 
tion,   cancer    of    ovaries,  cancer 

of  breast  and  cancer  of  uterus) 
Connecticut,  108, 113,  422, 455-457 
Connective-tissue   congestion  and  cancer, 

183 
Connective- tissue  tumors,  10  (see  sarcoma) 
Consanguinity  and  cancer,  201-204 
Constantinople,  Turkey,  701 
Contact  infection,  202-207 
Contagion    (see    infection    and    parasitic 

theory) 
Continental    United    States    (see    United 

States) 
Contributory   causes,  44,   45,  46,  168-169 

(see  causation) 
Control,  cancer,  problem  of,  103,  171,  215- 

217,  777-786 
Controversies,  useless  statistical,  43-44 
Copenhagen,  Denmark,  639 
Cooks,  314 
Coopers,  313 

Copts,  cancer  among,  136 
Corea,  178 

Corner  houses  and  cancer,  197 
Corrected   death   rates    (see   standardized 

death  rates) 
Costa  Rica,  140-141,  759 
Creoles  in  Sierra  Leone,  cancer  among,  36, 

137  (see  negroes) 
Croatians,  cancer  among,  686 
Crocker,  George,  Special  Research  Fund, 

151, 178, 182 
model  cancer  blank  of,  294 
Crude  death  rates  (see  standardized  death 

rates) 
Cuba,  39,  123,  124,  125,  140-141,  413,  754, 

756 
Cysts  and  other  tumors  of  the  ovary,  282 
Cytomata,  definition  of,  10 
classification  of,  272 

Dampness  and  cancer,  190-191,  197,  198, 
199,  203 

Danish  cities  (see  Denmark) 

Danish  West  Indies,  140-141 

Dayton,  Ohio,  128, 497-499 

Death  certification,  2-5,  23,  27,  32,  82-84 

Death  rates,  variations  in,  1,  7,  12,  13,  18, 
25,  30,  39,  40,  46,  47,  77-78, 128 
cancer,  maximum,  46 
crude  (see  crude  death  rates) 
European  countries,  46,  47 


814 


INDEX  OF  SUBJECTS 


Death  rates,  (coniinued) 

general,  decline  in,  17  (see  mortality) 

standardized  (see  standardized  death 
rates) 
Debility,  clinical  significance  of,  169-170 
Decrease  in  cancer,  40,  94,  216 
Decrease  in  chimney-sweeps'  cancer,  49 
Definition,  cancer,  difficulty  of,  4 

adenoma,  10 

angioma,  10 

carcinoma,  10,  34, 167 

chondroma,  10 

endothelioma,  10 

fibroma,  10 

glioma,  10 

leiomyoma,  10 

lipoma,  10 

lymph-angioma,  10 

myxoma,  10 

osteoma,  10 

rhabdomyoma,  10 

sarcoma,  10,  34, 167  (see  classification) 
Delafield  and  Prudden,   tumor  classifica- 
tion of,  9-10 
Denmark,  cities  of,  40, 134,  637-638 
Denver,  Colorado,  128,  500-501 
Dermatitis,     Roentgen-ray      (see     X-ray 

dermatitis) 
Dermoid  cyst,  275 
Detroit,  Michigan,  128, 501 
Development  and  growth  (see  growth  and 

development) 
Diabetes   and   cancer,  45,   119,  187,  192- 

194,  220 
Diagnosis,  cancer,  4,  6,  78,  81,  169-170 

differential,  22 

difficulties  of,  4, 5, 11, 103, 157-158 

early,  importance  of,  42, 154, 171 

erroneous,  21,  37-38, 123-125 

and  increase  of  cancer,  18,  23,  24,  25, 
28, 37, 38 

microscopical,  288-289 

terminal,  6,  22,  34 
Diet  and  cancer,  138, 174-179, 182,  220 
Diet  and  retarded  growth,  176 
Digestion  and  cancer,  176 
Digestive  diseases,  mortality  from,  440-441 
Digestive  organs,  cancer  of,  32,  33 
Discharges,  clinical  significance  of,  169-170 
Disease  classification,  20  (see  classification) 
District  of  Columbia,  U.  S.  A.,  108,  128, 
573-581 

cancer  in,  by  conjugal  condition,  98 

cancer  in,  by  race,  15, 16, 131 
Domestic  servants,  56,  75,  306-312,  315 
Drainage  and  cancer,  203  (see  dampness) 
Drapers,  57 

Draymen,  teamsters  and  drivers,  314 
Dresden,  Germany,  cancer  exhibit  of,  106, 

659 
Drinking  habits  and  cancer  (see  alcoholism) 
Drinking  water  and  cancer,  172 
Dublin,  Ireland,  624 


Duodenum,  cancer  of,  176 
Duration,  of  cancer,  59,  60,  115,  116,  165, 
166, 168,  220,  623 
of  insurance  and  cancer,  83,  91,  96,  97, 

166 
oflife,  effect  of,  23 
Dutch  East  Indies,  713 
Dutch  Guiana,  140-141 

Early  observations  on  cancer,  78 

Early  symptoms,  importance  of,  209  (see 

diagnosis) 
Eastern  Hemisphere,  cancer  mortality  of, 

143-144 
East  Indians,  cancer  among,  136,  138,  140, 

705,  738 
East  Prussia,  cancer  campaign  in,  213  (see 

Winter,  Georg) 
Economic  condition  and  cancer,   152  (see 

poverty  and  wealth  and  well-to-do) 
Ecuador,  140-141 
Eczematous  ulcerations  and  cancer,  52-54 

(see  tar  and  pitch  industry) 
Edinburgh,  Scotland,  122,  616-617 
Editors  and  journalists,  314 
Education  and  publicity  and  cancer,  171, 

208-209,  212-217,  777-785 
Educational  campaign  against  cancer,  209- 

217 
Educational  pamphlets,  215 
Egypt,  136, 178 

Egyptians,  cancer  among,  15, 136 
Electrical  workers,  313 
Elevator-tenders,  314 

Emaciation,  clinical  significance  of,  169-170 
Embryonic  rests,  theory  of  cancer,  202,  205 
Encephaloid,  classification  of,  268,  273,  276 
Endothelioma,  10,  273 
Engineers,  72, 313 
England  and  Wales,  13,  23-24,  30,  38-40, 

42-43,  70-72,    107,    123-125,    134, 

135,   167,  179,   191-193,   240-241, 

306-312,  414,  596-604 
accessible  and  inaccessible  cancers  in, 

33-37 
cancer  and  gout  in,  191 
cities  of,  226-227 

increase  of  cancer  in,  33,  84-90, 193 
mortality  from  appendicitis  in,  194 
mortality  from  diabetes  in,  193, 
mortality  from  sarcoma  in,  167 
occupational  mortality  in,  306-312 
standardized  death  rates  of,  310-312 
Environment  and   cancer  122,   197,   203- 

204 
Epiblast  tumors,  269,  271 
Epithelial-tissue  type,  10 
Epithelioma,  definition  of,  8-9, 10,  274 
Erfurt,  Germany,  63 
Errors  in  diagnosis  and  statistics,  1,  21, 129, 

200  (see  autopsy  records) 
Errors    of    development,    tumors    arising 

from,  270 


53 


815 


INDEX  OF  SUBJECTS 


Esquimos,  cancer  among,  147 

Essen  a/R.,  Germany,  657 

Ethnological    distribution,    36,    128     (see 

race) 
Europe,  countries  of,  46,  106, 133-136,  219, 
594-595 
cities  of,  145 
Europeans,  cancer  of,  in  Africa,  704-705 
in  Ceylon,  15,  710 
in  Dutch  East  Indies,  713 
in  Fiji,  738 
in  Hongkong,  714 
in  Indi^  177 
in  Manila,  719 
Exophthalmic  goitre  (see  goitre) 
Experiments,  cancer,  on  animals,  173,  176 
External  cancers,  increase  in,  31,  86,  87,  89, 
177,  203 
origin  of,  203 
External  and  internal  cancers  (see  internal 
cancers,   also   accessible   and   in- 
accessible) 
Extrinsic  origin  of  cancer,  197,   206   (see 
environment  and  irritation) 

Fallacies,  statistical,  2,  3,  22,  23,  41,  43, 

162, 203,  209 
Family  history  of  cancer,  91-92,  95,  97,  116, 

152,   171-173,  200,  204,  220  (see 

heredity) 
records  of,  value  of,  172 
Farmers,  57  (see  agricultural  workers) 
•  Farmhouses,  cancer  in,  188-189, 198,  203 
Fatality  rate,  158, 159, 163,  264-265 
Female  generative  organs,  cancer  of   (see 

generative  organs) 
Females,  cancer  mortality  of,  12, 13,42, 110, 

112 
in    insurance   experience,    96-98    (see 

males  and  sex) 
Fertilizers  and  cancer,  64 
Floods  and  cancer,  105, 190-191 
Florence,  Italy,  692 
Fibro-adenoma,  varieties  of,  5 
Fibroma,  definition  of,  9, 10,  274 
Fiji,  hospital  statistics  of,  737-738 
Fijians,  cancer  among,  737-738 
Filipinos,  cancer  among,  719 
Finland,  640-641 

and  Sweden,  641 
Firemen,  313 

First-bom,  cancer  among,  154 
Fish  diet  and  cancer,  174 
Fish,  endemic  goitre  in,  180-182 

thyroid  carcinoma  of,  180-182 
Fishermen,  57, 71,  306-313 
Fishmongers,  57 

Food  and  cancer  (see  diet  and  nutrition) 
Food  disease,  cancer  a,  183 
Foreign  countries,  133-145,  403-417,  582- 

775 
Foremen,  313 
Forfar,  Scotland,  197 


Forms  of  cancer,  international  classifica- 
tion of,  276-280 
Fra'nce,  39, 40, 106, 134-136,  670 

League  against  cancer,  213 
Frankfurt  a/M.,  Germany,  30,  31,  32,  33, 
105,  654-656 

cancer  classification  of,  31 
Free  Career  Hospital,  Brompton,  159 
Freetown,  Sierra  Leone,  136, 137, 706 
French  cities,  226  (see  France) 
Fuel  briquettes,  manufacture  of,  51-54,  69 
Fukien,  China,  hospital  statistics  of,  715 
Furriers,  65 

Galen,  cancer  theory  of,  5,  6 
Gall-bladder,  cancer  of,  117,  120,  156,  176, 

187 
Gall-stones  and  cancer,  156,  185,  186-187, 

219 
Galton  Laboratory,  57 
Gardeners,  49,  62,  72 
Gas  industry  (see  tar  and  paraflBn  workers, 

also  patent-fuel  industry) 
Gastric  cancer,  176  (see  stomach  and  liver) 

blank,  302-303 

and  ulcer,  110,  117,  156,  187 
Gastric  disturbances,  significance  of,  176 
Gas-workers,  57,  71,  72,  306-312 
General  Memorial  Hospital,  159,  296-303 
Generative  organs,  female,  cancer  of,  16, 
32,  33*  77,  99,  100,  110-111,  113- 
115,   116-121,  122-125,  130,   135, 
139,158,160,163,316-775 

by  conjugal  condition,  98 

estimated    mortality   in    the    United 
States  from,  77 

international  comparison,  228 
Generative  organs,  male,  cancer  of,  177 
Geneva,  Switzerland,  678 
Genito-urinary  organs,  cancer  of,  215 
Genoa,  Italy,  691 
Geographical  pathology,  11,  26,  104,  105, 

122-125,  219,  220 
Geologic  conditions  and  cancer,  203,  204 
Germans,  cancer  among,  680,  686 
Germany,  33, 40, 58,  76, 134, 135, 642 

cancer  census  of,  74-76 

cities  of,  226 

insurance  experience  of,  33 

society  for  cancer  research  of,  6,  41,  62 
Gibraltar,  135,  628 
Gilgit,  India,  goitre  in,  180-181 
Glasgow,  Scotland,  617 
Glass-workers,  306-313 
Glioma,  10,  274 
Goitre,  definition  and  etiology  of,  181 

Commission,  Swiss,  180 

in  fish  (see  thyroid  carcinoma) 
Goteborg,  Sweden,  637 
Gould  and  Pyle,  tumor  classification  of,  11, 

180,  273-275 
Gout  and  cancer,  187, 191-192,  219 

mortality  from,  191 


816 


INDEX  OF  SUBJECTS 


Grease  manufacture,  52 
Greater  New  York  (see  New  York) 
Greece,  135,  699 
Greeks,  cancer  among,  701 
Grocers,  48,  57,  306-312,  314 
Growth  and  development,  disorders  of,  4, 
153,  155,  166-170,  202,  220,  270 
Guano-workers,  65 
Guayaquil,  Ecuador,  760 
Gypsies,  cancer  among,  152  , 

Hague,  The,  Holland,  665-666 

Hamburg,  Germany,  651 

Hammerfest,  Norway,  142,  634 

Harness-makers,  313 

Hartford,  Connecticut,  128,  502-503 

Hatch,  cancer  classification  of,  271 

Hatters,  306-313 

Havana,  Cuba,  756 

Havre,  France,  673 

Hawaii.  138, 139,  739 

cancer  of  breast  in  Japanese  women 
in, 125 

Hawaiians,  cancer  among,  739 

Health  of  cancer  patients  152  (see  physical 
condition) 

Health  Education  League,  215-216 

Heart  diseases,  mortality  from,  440-441 

Heidelberg,  Germany,  160 

Height  and  cancer,  97,  98,  203 

Heligoland,  650-651 

Heredity  of  cancer,  78, 79,  89,  90,  91-92, 95, 
97, 116,  152,  171-173,  200-201,  220 
(see  family  history) 

Hernia  and  cancer,  117 

Hesse,  Germany,  149,  650 

Hindoos,  cancer  among,  399 

Hippocrates,  knowledge  of  cancer  of,  5 

Histiomata,  classification  of,  272 

Histogenetic  principle  of  classification,  9 

History  of  cancer,  5,  6, 11 

Hoboken,  New  Jersey,  128,  504 

Holland,  40, 134, 135,  219,  244-245,  661-662 
cancer  census  of,  40 
cancer  among  Jews  in,  150 
cancer  in,  by  organs  and  parts,  123-125 

Hongkong,  China,  137,  138,  714 

Hospital  experience  data  (see  American 
Oncologic,  Barnard  Free  Skin  and 
Cancer,  Charity,  Collis  P.  Hunt- 
ington, Free  Cancer,  General 
Memorial,  Johns  Hopkins,London, 
Massachusetts  General,  Middle- 
sex, etc.) 

Hospital  records,  158-161,  220 

Hospital  statistics,  importance  of,  160-161, 
221 

Hostlers  and  stablemen,  314 

Housing  conditions  and  cancer,  122,  204 
(see   cancer-houses) 

Humidity  and  cancer,  191, 192  (see  climate) 

Hungary,  39, 47, 107, 134,  135, 136,  638-686 
cancer  census  of,  36,  71,  206, 314 


Huntington,  Collis  P.,  Memorial  Hospital, 
161 

Husband  and  wife,  cancer  among,  202,  205, 
206,  207  (see  conjugal  condition 
and  marital  infection) 

Hydatid  tumors  of  liver,  281,  428-429 

Hydrochloric  acid,  significance  of,  176 

Hypemutrition  and  cancer,  154  (see  over- 
nutrition,  diet  and  weight) 

Hyphomycetes  in  plants,  198 

Hypoblast  tumors,  269,  271 

Iceland,  cancer  census  of,  640 

Ignorance,  menace  of,  47 

Ill-defined  cancers  (other  organs  and  parts) , 

77,110-111,115,130,139 
Immunity,  surgical,  to  infection,  207 
Imperial   Cancer  Research   Fund,  cancer 
classification  of,  283 
on  cancer-houses,  198-199 
on  cancer  increase,  17-18,  31,  34, 135, 

138, 161 
on  collection  of  statistics,  138 
Inaccessible  cancers,  30-31, 84, 86  (see  inter- 
nal and  accessible,  also  external) 
Increase  in  cancer,  7, 1 1, 12, 13, 15, 16, 17,18, 
23,  24,  25,  26,  27,  28-47,  78, 82,  85, 
86,  87,  89,  90,  105,  133,  134,  141, 
145,  160,  203,  218,  220,  305-775 
by  age  and  sex,  111,112,  305-775 
in  American  cities,  127, 128,  450-581 
in  Australia,  193 
ofbreast,  113-114,  447 
of  buccal  cavity,  113-114,  444 
by  conjugal  condition,  98-101 
in  European  countries,  46,  47,  191-192, 

193,  594 
of  generative  organs,  female,  113-114, 

of  ill-defined  or  not  specified  organs, 

113-114,449 
insurance  experience  of,  81,  82,  84,  85, 

86,  93,  94 
of  internal  and  external  organs,  87,  111, 

113,114,219 
international  statistics  of,  224-265, 305- 

775 
in  New  England  States,  New  York, 

New  Jersey,  127 
by  organs  and  parts,  according  to  age 

and  sex.  United  States,  113-114, 

443-449 
by   organs   and   parts,   England   and 

Wales,  598-600 
of  other  or  not  specified  organs,  113- 

114,  449 
of  peritoneum,  intestines  and  rectimi, 

113-114,  446 
by  race,  128, 137 
of  skin,  113-114,  448 
of  stomach  and  liver,  113-114,  445 
in  United  States,  28-47,  77-78. 111,112, 

113-114,  127-128,  146 


817 


INDEX  OF  SUBJECTS 


India,  137, 138, 177 

cancer  of  cheek  among  natives  of,  122 
(see  betel-nut  chewing  and  Kangri 
cancer) 
cancer  among  natives  of,  138 
Indiana,  108, 423 
Indianapolis,  Indiana,  128,  505 
Indians,  North  American,  cancer  among, 

15,147,151-152,178,219 
Indigestion  and  cancer,  170 
Industrial  disease,  cancer  as  an,  48-76 
Industrial  insurance  experience,  Prudential, 
of  America,  45,  101-102,  313-314 
(see    insurance    companies    and 
Prudential) 
Inebriate  asylums,  cancer  in,  184 
Inebriety   and  cancer,  57,    184,   189   (see 

alcoholism) 
Infection  in  goitre,  181 
Infectious,    cancer    not,     192,     206     (see 

parasitic  theory) 
Infectiousness  of  cancer,  192, 199,  203,  205, 

207,  220 
Inheritance   of   cancer   (see  heredity  and 

family  history) 
Injuries    and    cancer    (see   accidents   and 

traumatism) 
Innkeepers,  306-315 
Innocency  and  malignancy,  8  (see  tumors, 

benign) 
Innocent  tumors,  classification  of,  270 
Inoperable  cancer,  165,  209 
Inquiry  blanks,  cancer,  27 
Insanity  and  cancer,  55,  58,  208-209,  220 

(see  worry) 
Institutional  treatment,  209 
Institutions,  cancer  deaths  in,  127, 129 
Insurance  agents,  314 

Insurance    companies,    cancer    mortality 
experience     of,     American     and 
foreign,  316-401 
Mina,  358 
Alte  Leipziger,  94 
American,  95-98,  356,  357 
Anker  (Vienna),  392 
Assicurazioni  Generali,  94,  392-393 
Australian  Mutual  Provident,  398 
Austrian,  390-392 
Austro-Hungarian,  94-95 
Basle  Life,  396 

British  Empire  Mutual,  83,  363-364 
British  and  German  companies,  376 
Clergy  Mutual,  92,  364-365 
Deutsche  (Lubeck),  382 
Deutsche  (Potsdam),  377 
Deutscher  Kriegerbund,  377 
Donau  (Vienna),  393 
Dutch  East  Indian,  399 
Equitable  Society  (London),  365 
First  General  Association  Austro-Hxm- 

garian  officials,  393 
Fonciere  (Budapest),  94,  396 
Foreign,  361-363 


Freia,  Bremen-Hannoversche  Lebens- 
versicherungs-Bank,  377 

Friedrich  Wilhehn,  378-381 

German  (combined),  376 

Germania,  Germany,  94,  382 

Gotha,  33,  83. 383-385 

Gresham  Life,  92, 366 

Janus,  Mutual  Life,  393 

Japanese,  401 

Karisruhe,  385-387 

La  Suisse  (Lausanne),  396 

Leipzig,  387-388 

Magdeburg,  388 

]Margra\'iate  Mora"\aa  (Briinn),  394 

Meiji  Life  (Japan),  137,  399-400 

Metropolitan  (London),  82,  366 

Mutual  Life  (Krakau),  394 

Mutual  Life  (New  York),  90,  91,  92, 
93, 192,  359-360 

New  York  Life,  360 

Northwestern  Mutual  Life,  93,  94,  361 

Oriental  Government  Security  Life, 
177,  399 

PhoenLx  (Austrian),  94,  394 

Praha,  Mutual  Life,  395 

Prudential  (America),  45,  70,  72,  101- 
103,  131,  153,  166,  262-263,  312- 
314  321-355 

Prudential  (London),  90,  367-369 

Riunione  Adriatica  Sicurta,  94,  395 

Saxon  Militarj'  Life,  389 

Scottish  Amicable  Life,  80,  370-371 

Scottish  Union  and  National,  372 

Scottish  Widows'  Fund,  78,  80,  82,  83, 
84,  85-89,  372-376 

Standard  Life  (Edinburgh),  80-82 

Stuttgart  Life,  389 

Teutonia,  389 

Thule,  397 

Universale,  Industrial,  396 

Victoria  Life,  390 

Washington  Life,  91,  361 
Insurance   medicine    and   cancer,    77-103, 

214,  218,  316-401 
Intermediate  type  of  cancer,  283 
Internal  cancers,  5,  28,  29,  31,  86,  87,  89, 
177    (see   accessible,   inaccessible 
and  external) 
International  cancer  question  form,  291-292 
International  Conference,  213 
International  statistics,  16,  106-108,  141- 

145,  219,  224-265,  305-775 
Intestinal  cancer,  diagnosis  of,  158  (see  peri- 
toneum, intestines   and    rectum) 
Intestines,  cancer  of,  117, 121 
Invalidity,  cancer  as  cause  of,  48 
Involvement,  cancer  and,  120, 121 
Ireland,  12,  39,  107, 134-135, 136, 167,  242- 

243,414,618-624 
Ironmongers,  306-312 
Iron-moulders,  313 
Iron  and  steel  workers,  313 
Irritability,  theory  of  cancer,  73, 74 


818 


INDEX  OF  SUBJECTS 


Irritation  and  cancer,  48-76,  156,  183-187, 
202,  782-783  (see  accidents  and 
traumatism) 

Isle  of  Guernsey,  134,  135 

IsleofMan,  135,  626-627 

Italians,  cancer  among,  680 

Italy,  39,  134,  135,  136,  250-251,  416,  688- 
690 
cities  of,  226-228 

Jamaica,  40,  748-749 

Janitors,  314 

Japan,  39,  137,  138,  139, 178,  179,  252-253, 

415,  715-717 
cancer  in,  by  organs  and  parts,  123-125 
Japanese  hospital  experience,  139 
Japanese  insurance  experience,  137 
Japanese   women,   scarcity   of    cancer    of 

breast  among,  125,  219 
Jaw,  cancer  of,  117 

Jersey  City,  New  Jersey,  128,  205,  506-507 
Jewelers,  313 
Jews,  cancer  among,  29,  31,  40, 147-151, 193, 

650,  658,  682-683,  688,  701 
diabetes  among,  192-193 
Jews  and  non-Jews,  cancer  among,  40, 148, 

650,  658,  688 
Johannesburg,  South  Africa,  136,  704 
Johns  Hopkins  Hospital,  statistics  of,  158, 

159,  161-163,  264-265 
autopsy  records  of,  86 
Journalists,  72 

Kangri  cancer  of  Kashmir,  30,  122,  147, 

174, 175 
Kansas  City,  Missouri,  128,  507 
Kentucky,  108,  423 
Kidneys,    cancer    of,     117     (see     urinary 

organs) 
Kirkintilloch,  Scotland,  197 
Kolozsvar,  Hungary,  160 
Konigsberg,  Germany,  660 
Kristiania,  Norway,  633 
Kyoto,  Japan,  719 

Laborers,  57,  74,  75,  313  (see  common 
laborers) 

Labrador  and  Newfoundland  (see  New- 
foundland and  Esquimos) 

Lahore,  India,  Mayo  Hospital,  177 

Laity,  cooperation  of  in  cancer  control,  214 

Lampblack-workers,  59  (see  soot-workers) 

La  Paz,  Bolivia,  760 

Latitude  and  cancer,  142-144,  219,  403-409 
(see  climate) 

Laundry-workers,  72, 75,  313 

Law  of  large  numbers,  statistical,  3,  41, 142, 
145,  218 

Lawyers,  306-312 

Lead-poisoning,  117 

Lead-workers,  65 

Leather-workers,  62 

Leeds,  England,  611 


Le  Havre,  France,  673 

Leipzig,  Germany,  659 

Leipzig  Communal  Sick  Fund,  73,  75 

Leonidis,  cancer  theory  of,  5 

Leprosy  and  cancer,  187, 199,  219 

Liege,  Belgium,  668 

Life  insurance  and  cancer  (see  insurance) 

Light  exposure  and  cancer,  68  (see  actinic 

stimulation) 
Lille,  France,  673 
Lima,  Peru,  141,  761 
Limestone  formation  and  goitre,  180 
Lip,  cancer  of,  56,  117,  135,  158,  184,  185- 

186,  210  (see  buccal  cavity) 
Lipoma,  definition  of,  9, 10,  274 
Liquor-dealers,  314 
Lisbon,  Portugal,  697 
Literature  of  cancer  statistics,  2 
Liver,  cancer  of,  117, 120, 121  (see  stomach 

and  liver) 
Liver  diseases,  37 
Liver,  stomach  and  oesophagus,  cancer  of, 

122-125   (see   stomach  and  liver) 
Liverpool,  England,  608-609 
Local  cancer  studies,  204 
Local  incidence  and  variations,  cancer,  11, 

30,  104-105, 108-109,  204-205 
London,  England,  23,  29,  260-261,  604-606 
London  Hospital,  150 
London  Radium  Institute,  210,  211,  212, 

221 
London   Society,   early,   for   investigating 

cancer,  213 
Longitude  and  cancer,  143  (see  latitude  and 

climate) 
Longshoremen  and  stevedores,  314 
Los  Angeles,  California,  128,  508 
Louisville,  Kentucky,  128,  508 
Low-lying  districts  and   cancer,   191   (see 

swamps) 
Luckau,  Germany,  197 
Luetic  antecedents  and  cancer,    190    (see 

syphilis) 
Lunatic  asylums,  cancer  in,  161-162 
Lunatics,  cancer  among  (see  insane) 
Lung  tumors,  173 
Lungs,  cancer  of,  61,  68, 118, 121 
Lymph-angioma,  10,  274 
Lympho-sarcoma,  274 
Lyons,  France,  672 

Macao,  China,  707 
Machinists,  62,  313 
Madison  County,  New  York,  cancer  area, 

201-202 
Madrid,  Spain,  694 
Magyars,  cancer  among,  680,  686 
Mail-carriers,  314 
Maine,  108,  422,  458-459 
Malaria  and  cancer,  187,  204,  205 
Malays,  cancer  among,  15,  710 
Males,  cancer  among,  12,  13,  42,  97,  316- 

775 


819 


INDEX  OF  SUBJECTS 


Males  and  females,  cancer  amcng,  316-775 
Malignancy,  degree  of,  48, 166-167, 169,  220 

indications  of,  167 
Malignant  disease  (see  cancer) 
Malnutrition  and  cancer,  174,  176,  191-192 

(see  diet,  gout,  overnutrition  and 

weight) 
Malta  and  Gozo,  628-629 
Maltsters,  57,  72,  73,  306-314  (see  brewers) 
Mammary  cancer  blank,  300-301 
Man  and  animals,  cancer  in,  173-174  (see 

animals) 
Manchester,  England,  612-613 
Manhattan-Bronx,  N.  Y.,    128    (see  New 

York  City) 
Manila,  Philippine  Islands,  137, 138,  719 
Marble  and  stone  workers,  313 
Marital  infection  in  cancer,  98,  205-206, 

219  (see  conjugal  condition   and 

cancer  a  deux) 
Marital  infection  in  tuberculosis,  206 
Maryland,  108,  423 

cancer  in,  by  race,  236-237 
Masons,  313,  315 

Massachusetts,  39,41, 108,113,423,460-462 
Massachusetts  General  Hospital,  20,  129, 

164 
Mauritius,  136, 703 
Maximum  cancer  death  rate,  134, 141 
Mayo  Clinic,  statistics  of,  110, 156, 164 
Mayo  Hospital,  Lahore,  177 
Meat-eating  and  cancer,  175,  178  (see  diet 

and  vegetarianism) 
Mechanical  irritation,   theory   of   cancer, 

205  (see  traumatism) 
Medical  aspects  of  cancer  problem,  1,  24, 

89,90 
Medical  selection,  value  of,  77,  95-97,  101, 

103,  219 
Medicine,  progress  of,  6 
Medico- Actuarial  Investigation,  95-98,  219, 

220,  356 
Medico-legal  aspects,  49 
Mellon  Institute,  smoke  investigations  of,  64 
Memphis,  Tennessee,  128,  509-510 
Menace  of  cancer,  42,  47,  131, 141-142, 146, 

162-163,  218 
Mental  condition  and  cancer,  152,  207-208 
Meso blast  tumors,  269,  271 
Metabolic  disorders  and  cancer,  132,  156, 

174-178,   180,  182,  220  (see  diet, 

overnutrition  and  weight) 
Metal-workers,  62,  74,  75,  306-312 
Mexico,  105, 140-141 
Mexico,  City  of,  Mexico,  758-759 
Mice,  cancer  heredity  in,  173-174 
JVIichigan,  108, 424 

cancer  census  of,  35 
Micro-organisms  and  cancer,  187-188 
Micro-organisms  and  goitre,  180-182 
Microscopical  examinations,  8,  18,  34,  84, 

288-289  (see  autopsy) 
Middlesex  Hospital,  92,  206 


Milan,  Italy,  692 

Mill  operatives,  313 

Millers,  71,  306-314 

Milwaukee,  Wisconsin,  128,  510-511 

Miners,  56,  61,  62,  68,  69,  70,  75,  315 

Minneapolis,  Minnesota,  128,512-513 

Minnesota,  108,  424 

Missoiu-i,  108,  424 

Mobile,  Alabama,  16 

Mohammedans,  cancer  among,  177,  701 

Moles,  malignant,  155, 157, 187 

Molokai  Leper  Settlement,  187 

Montana,  108,  424 

Montevideo,  Uruguay,  141,  775 

Monthly  cancer  death  rate  in  New  York, 
Massachusetts,  New  Hampshire 
and  Connecticut,  113,441 

Montreal,  Canada,  743 

Moors,  cancer  among,  15 

in  Ceylon,  cancer  among,  710 

Mortality  from  cancer  and  all  forms  of 
malignant  and  non-malignant 
neoplasms,  224-265,  305-775 
(see  autopsy  records,  statistics, 
and  indexed  entries  for  all  civil- 
ized countries  and  their  minor 
civil  divisions,  by  age,  conjugal 
condition,  latitude,  occupation, 
organs  and  parts,  race,  religion, 
sex,  etc.) 

Mortality  from  cancer,  estimate  of,  47,  77, 
146,  427,  435 

Mortality  charts,  224-265 

Mosambique,  Africa,  707 

Moscow,  Russia,  697 

Mountain  districts,  cancer  in,  105 

Mouth,  cancer  of,  118,  120,  121  (see  buccal 
cavity) 

Mulattoes,  cancer  among,  706-707  (see 
negroes  and  Creoles) 

Multiple  cancer  cases,  200,  202 

Munich,  Germany,  136, 160,  657 
cancer  of  Jews  in,  148-149 

Muscle- tissue  type  of  cancer,  10 

Musicians,  314 

Myoma,  definition  of,  9,  274 

Myxoma,  definition  of,  9,  10,  275 

Nancy,  France,  673 

Naphtha  industry,  58 

Naples,  Italy,  691 

Nashville,  Tennessee,  128 

Natal,  South  Africa,  136,  705 

Native  races,  cancer  among  (see  race  and 
primitive  races) 

Natural  history  of  cancer  (see  history) 

Neck,  cancer  of,  118 

Negroes,  cancer  among,  15,  128,  129,  131, 
132,  140,  147,  159,  185,  431,  706- 
707  (see  Africans  and  Creoles) 
Africans,  cancer  among,  704 

Neoplasms,  187  (see  cancer) 

Nephritis,  mortality  from,  440-441 


820 


INDEX  OF  SUBJECTS 


Nerve-tissue  type  of  cancer,  10 

Netherlands,  107 

Neuroma,  275 

Newark,  New  Jersey,  128,  517-518 

New  England  States,  New  York  and  New 

Jersey,  472 
Newfoundland  and  Labrador,  140-141,  746 
New  Hampshire.  108, 109,  423,  463-464 
cancer  mortality  in,  by  season,  113 
New  Haven,  Connecticut,  128,  518-520 
New  Jersey,  108,  425,  465 
New  Jersey,  New  York  and  New  England 

States,  472 
New  Orleans,  Louisiana,  IG,  128,  521-531 
New  Orleans  Charity  Hospital,  132,  158, 

159  526-531 
New  South  Wales,  138,  723-725 
New  York  City,  128,  258-259,  532-542 
New  York,  New  Jersey  and  New  England 

States,  472 
New  York  Pathological  Institute  (see  New 

York  State  Institute  for  Study  of 

Malignant  Disease) 
New  York  State,  108,  425,  466 

cancer  mortality  in,  by  season,  113 
New  York  State   Department  of   Health 

cancer  blank,  290-291 
New  York  State  Institute  for  Study  of 

Malignant  Disease,  114-121 
model  blank,  121 
New  Zealand,  40,  107,  138,  204-205,  736- 

737 
Nicaragua,  140-141,  759 
Nice,  France,  672 
Nickel-mine  workers,  70 
Non-malignant  neoplasms,  classification  of, 

279-280 
Non-surgical  treatment,  209 
North  American  Indians,  cancer  among  (see 

Indians) 
North  Carolina,  425 
Northern  Territory,  Australia,  138,  735 
Norway,  40,  134,  135,  136,  167,  193,  415, 

629-633 
cancer  in,  by  organs  and  parts,  123-125 
mortality  from  diabetes  in,  193-194 
mortality  from  sarcoma  in,  167 
Notification,  cancer,  value  of,  204 
Nova  Scotia,  745 
Nuremberg,  Germany,  660 
Nursing  and  cancer,  199,  207 
Nursing,  educational  value  of,  215 
Nutrition  and  cancer,   132,   153,  174-179, 

182,  183,   192-193   (see  diet  and 

metabolism) 

Obesity  and  cancer,  174,   183  (see  weight 

and  anthropometry) 
Occupation  and  cancer,   48-76,    152,   219, 
305-315 
mortality  statistics  of,  73 
by  organs  and  parts,  74-75 
Occupation  and  tumor,  48 


ffisophagus,  cancer  of,  118, 183 

(Esophagus,  stomach  and  liver,  cancer  of, 
122-125 

Ohio,  108 

Old  age,  cancer  in  extreme,  14,  38,  42,  109, 
114,  153-154,  183,  204  (see  age) 

Old  persons,  proportion  of,  204 

Omaha,  Nebraska,  128,  542 

Oncologic  Hospital,  159 

Oncology,  definition  and  terminology  of, 
1,  4,  6,  20 

Ontario,  Canada,  39, 741 

Operable  and  inoperable  cancers,  propor- 
tion of,  165 

Operations,  early  record  of,  5 

and  cancer  death  rate,  40  (see  surgical) 

Operative  treatment,  results  of,  113,  215 

Organs  and  parts,  cancer  mortality  by,  17, 
19,  27,  32,  74-75,  77,  87,  88,  100, 
110-111,  113-114,  115,  116-125, 
129-130,  139,  141,  158,  159,  163, 
177,  219,  228-231,  316-775. 
international  statistics  of,  239-261, 316- 
775 

Orifices  of  body  and  cancer,  156 

Osaka,  Japan,  718 

Osteoma,  definition  of,  9, 10,  275 

Ovarian  tumors,  110,  428-429 
and  cancer,  120 

Ovary,  cancer  of,  100,  110,  118,  121  (see 
conjugal  condition  and  generative 
organs) 

Overeating  and  cancer,  178  (see  diet  and 
nutrition) 

Overfeeding  and  thyroid  carcinoma  in  fish, 
181-182 

Overnutrition  and  cancer,  174,  178,  220 
(see  diet  and  nutrition) 

Overweight  and  cancer,  153,  220  (see 
anthropometry  and  weight) 

Pain,  clinical  significance  of,  155, 169,  170 

Painters,  313 

Palermo,  Italy,  693 

Pallor,  clinical  significance  of,  169-170 

Pancreas,  cancer  of,  118,  121,  192,  193 

Paperhangers,  313 

Papermakers,  313 

Papilloma,  definition  of,  8,  275 

Paraffin  industry,  49, 54, 55, 56, 58,  61, 64, 70 

Parana,  Brazil,  766 

Parasite,  cancer,  196-197,  202-205,  783 

Parasites,  plant,  classification  of,  198 

Parasitic  theory  of  cancer,  195-196,  197, 
198,  202-205,  220  (see  infection) 

Parasitical  origin  of  cancer,  181,  202-205, 
207,  220 

Parimaribo,  Dutch  Guiana,  753-754 

Paris,  France,  671-672 

Patent-fuel  industry,  51-54,  61  (see  tar  and 
paraffin  workers) 

Pathology  of  cancer,  historical  and  geo- 
graphical, 104 


821 


INDEX  OF  SUBJECTS 


Paupers  (see  poverty) 

Peddlers,  314 

Pelotas,  Brazil,  767 

Pembrey  and  Ritchie,  on  tumors,  4 
cancer  classification  of,  269-270 

Penang,  Straits  Settlements,  137-138,  712 

Pennsylvania,  108, 425 

Pennsylvania  Cancer  Commission,  165 

Peritoneum,  cancer  of,  118 

Peritoneum,  intestines  and  rectvun,  cancer 
of,  77,  110-111,  114,  115,  130,  132, 
139, 158, 159, 163, 228-265, 316-776 

Personal  history  of  cancer  patients,  116-121 

Peru,  140-141 

Petfograd,  Russia,  697 

Petroleum  industrj-,  58  (see  patent-fuel 
industry  and  tar  and  paraffin 
■workers) 

PharjTix,  cancer  of,  118, 119 

Philadelphia,  Pennsylvania,  128, 543-550 

Philippine  Islands,  137, 138, 178 

Phipps,  Henrj^  Institute,  188 

Phthisis  and  cancer,  34,  187-188 

marital  infection  in,   206    (see  tuber- 
culosis) 

Physical  condition  and  cancer,  153-155  (see 
personal  history  and  weight) 

Physicians,  57,  306-312,  314 

Physique  and  cancer,  152  (see  anthropome- 
try and  build) 

Pitch  industry,  49-55,  61,  69 

Pitch  ulceration  and  cancer,  69  (see  tar  and 
paraffin  workers,  also  patent-fuel 
industry) 

Pittsburgh,  Pennsylvania,  128,  551-554 

Plant  parasites,  198 

Plants,  cancer  in,  63,  68, 152, 179 

Plasterers,  72,  313 

Plumbers,  57,  314 

Pneimionia  and  cancer,  45, 118,  440-441 

Poles,  cancer  among,  680 

Policemen,  314 

PoljTiesians,  cancer  among,  738 

Poor  Law  institutions,  cancer  mortality  in, 
161-162 

Population  statistics,  by  age  and  sex,  435 

Porters,  57, 314 

Porto,  Portugal,  696 

Porto  Rico,  757 

Portsmouth,  England,  cancer  education  in, 
216,  781-782 

Portugal,  135,  694-696 

Portuguese  Guinea,  137 

Portuguese  in  Hawaii,  cancer  among,  739 

Portuguese  India,  137 

Post-mortem  records  (see  autopsy) 

Post-natal  growth  and  cancer  (see  growth 
and  development) 

Potassium  balance,  179 

Potters,  57,  306-313 

Poverty  and  wealth  and  cancer,  90, 
101,  122,  150-151,  177,  203  (see 
well-to-do) 


Precancerous  conditions,  155, 156, 157, 158, 
220 

Predisposition,  171 

Prevention  of  cancer,  215,  777-785  (see 
education) 

Previous  illness,  154 

Primary  seat  of  growth,  116-121 

Primitive  races,  cancer  among,  15,  36,  122, 
146, 147  (see  civihzation) 

Prince  Edward  Island,  745 

Printers,  56,  306-313 

Prisoners,  cancer  among,  55,  58 

Problem,  cancer,  nature  of,  2,  47,  105,  217- 
221 

Proctoscope,  use  of,  158 

Professional  classes,  56 

Prognosis,  157, 169,  170-171 

Proportionate  cancer  mortaUty,  13,  29,  77, 
_  93,  112-113 
in  insurance  experience,  72,  73,  89,  91, 

93,94 
among  rich  and  poor,  101-102 
by  sex,  440 

Prostate  gland,  cancer  of,  119 

Prostitution  and  cancer,  189  (see  syphilis) 

Protective  regulations,  52-53,  66,  69 

Protein  excess  and  cancer,  174  (see  nutri- 
tion) 

Pro^•idence,  Rhode  Island,  128,  555-557 

Prudential  (America)  mortahty  experience 
of,  13,  101-103,  262 

Prudential  (London)  mortality  experience 
of,  90,  367-369 

Prussia,  107,  213,  646-647 

Psammoma,  275 

Psychological  aspects  of  cancer,  47,  208  (see 
insanity  and  worry) 

Public  agitation,  objections  to,  208 

Public  institutions,  cancer  deaths  in,  161- 
162 

Publications  on  cancer,  215-217  (see  liter- 
ature) 

Pubhc-service  employees,  315 

QrARRTMEX,  56,  305-312 
Quebec,  city  of,  Canada,  744 
Queensland,  Australia,  138,  731-732 
Question  form  for  cancer  statistics,  27,  285, 
290-304 

Race,  14-16,  36,  42,  131,  132,  152,  172, 
234-237,399,431-775  (see  Chinese, 
Egj'ptians,  Japanese,  negroes, 
primitive  races,  etc.) 

Radio-acti^^ty,  54,  67,  185-186,  202,  205, 
211 

Radiological  examinations,  5 

Radium  Institute  of  London,  210,  211,  221 

Radium  and  radiotherapy,  209-212,  220 

Railway  employees,  71,  307-315 

Rainfall,  mean  annual,  143 

and    cancer,    191,    192     (see   climate, 
dampness  and  humidity) 


822 


INDEX  OF  SUBJECTS 


Rapidity  of   growth,  168  (see  growth  and 

development) 
Rare  types  of  cancer,  122 
Recommendations  on  cancer  control,  777- 

778 
Records  and  blanks,  cancer,  appendix  of, 

284-304 
Rectories,  old,  cancer  in,  198 
Rectum,  cancer  of,  119,  121,  158  (see  peri- 
toneum and  intestines) 
Recurrence,  cancer,  problem  of,   164-165, 

169, 220 
Registrar-General  of  England  and  Wales, 

reports  of,  13,  46,  98,  131,  162 
Registration    Area,    United    States     (see 

United  States) 
Rejection  rate  in  life  insurance,  cancer,  95 
Relative  cancer  mortality,  by  sex,  specified 

organs  and  parts,  601,  615,  631, 

676 
Religion  and  cancer,  151  (see  Jews) 
Renal  calculi  and  cancer,  187 
Reproductive  life  and  cancer,  204 
Research,  cancer,  problems  of,  2,  166,  217, 

221  (see  Imperial  Cancer  Research 

Fund  and  hospital  statistics) 
Resistance,  natural,  to  cancer,  182 
Respiratory  organs,  cancer  of,  32,  33  (see 

lungs,  miners  and  tuberculosis) 
Restaurant-keepers,  75  (see  innkeepers) 
Retired,  313 
Rheumatism  and  cancer,  154, 183, 187, 190- 

192,  205, 220 
Rhode  Island,  108, 425, 467-469 
Rich  and  poor  and  cancer  (see  poverty  and 

wealth) 
Richmond,  Virginia,  128, 558-561 
Rio  de  Janeiro,  city  of,  Brazil,  762 
Rio  de  Janeiro,  federal  district  of,  Brazil, 

762-763 
River  floods  and  cancer,  203  (see  dampness 

and  Thames  Valley) 
Rochester,  New  York,  128,  561-562 
Rodent  ulcer,  159, 195,  203 
Roentgen-rays,  66-67,  122, 147,  210-211  (see 

X-ray  dermatitis) 
Rome,  Italy,  691 
Roofers,  313 

Rosario  de  Sante  Fe,  Argentina,  771 
Rotterdam,  Holland,  666-667 
Roumania,  135-136, 701 
Roumanians,  cancer  among,  680, 686 
Royal  Infirmary  of  Edinburgh,  81 
Rubber-workers,  65,  313 
Rural  cancer  death  rate,  13 
Russia,  135 
Russian    Jews,   cancer    among,   148   (see 

Jews) 
Ruthenians,  cancer  among,  680, 686 

Sailors  (see  seamen) 

St.  John,  New  Brunswick,  746 

St.  Louis,  Missouri,  128,  570-571 


St.  Paul,  Minnesota,  128,  572 
St.  Thomas,  Danish  West  Indies,  751 
St.  Thomas  and  Principe,  707 
Salesmen,  314 

Saloon-keepers,  57,  71,  83,  314    (see  alco- 
holism,   bartenders    and    liquor- 
dealers) 
Salvador,  140-141 
San  Francisco,  California,  128,  129,  130, 

562-565 
Sanitary  precautions  and  cancer,  53, 54 
San  Salvador,  Salvador,  760 
Santiago  de  Chile,  city  of,  Chile,  141,  773 
Santiago  de  Chile,  province  of,  Chile,  773 
Sao  Paulo,  Brazil,  766 
Sarcoma,  definition  of,  9,  10,  14,  34,  102, 

167,  275 
incidence  of,  32,  99-100, 161, 167 
mortality  from,  14, 159 
Sarcomata  and  carcinomata,  131,  153,  167, 

196 
Savannah,  Georgia,  128, 129, 565-567 
Sawyers,  72, 313 
Saxony, 649 

Schizomycetes  in  plants,  198 
Schneeberg  mining  district,  cancer  in,  61, 

68,69 
School-teachers,  306-312, 314 
Scirrhus,  classification  of,  268,  273 
Scotland,  39, 134, 135, 167, 416, 613-615 

cancer  in,  by  organs  and  parts,  122-125 
deaths  from  sarcoma  in,  167 
Scrofula  and  cancer,  81, 187 
Scrotum,  cancer  of,  49,  50,  51,  52,  55,  56, 

59, 60,  61,62  (see  chimney-sweeps) 
Seamen,  57,  62,  65,  72,  204,  306-314 
Season,  cancer  mortality  by,  113,  441 
Seattle,  Washington,  128, 567-568 
Secondary  causes  in  cancer,  44-46 
Senility  and  cancer,  13, 14, 153  (see  growth 

and  development  and  old  age) 
Serbia,  135,  698-699 
Serbians,  cancer  among,  686 
Sex  and  cancer,  11,  12,  110-114,  131,  152, 

232-233 
international  statistics  of,  224-265, 305- 

775   (see  males  and  females  and 

generative  organs) 
Seychelles,  hospital  statistics  of,  713 
Shale-oil  workers,  54 
Shanghai,  China,  137, 138,  715 
Sheffield,  England,  607-608 
Shelf,  England,  cancer  education  in,  783- 

785 
Ship  and  boat  builders,  313 
Shoemakers,  48, 57, 71,  306-313,  315 
Siam,  178 
Sierra  Leone,   36,   136-137,   705-706    (see 

Africans  and  Creoles) 
Singapore,  China,  137, 138,  712 

hospital  statistics  of,  712 
Single  years  of  life,  cancer  mortality  by,  131 
Sinhalese,  cancer  among,  15, 710 


INDEX  OF  SUBJECTS 


Skin,  cancer  of,  32,  33,  51,  52,  62,  66,  77, 

110.  Ill,  114,  115,  119,  121,  122- 

125,  130,  139,  158,  159,  211,  215, 

236-265,  316-775 
Skotographic  action,  67 
Slaves,  cancer  among,  15  (see  negroes  and 

Creoles) 
Slavs,  cancer  among,  680 
Slovaks,  cancer  among,  686 
Slovenes,  cancer  among,  680 
Smelters,  315 

Smoke  and  cancer,  64  (see  soot) 
Smoking  and  cancer,  117,  121,  138,  185- 

186, 220 
Social    conditions    and    cancer,    76    (see 

poverty  and  wealth) 
Society  for  Control  of  Cancer,  American 

(see  American  Society  for  Control 

Soil  and  cancer,  152, 191, 202,  203,  205 

Soil  and  goitre,  180 

Soldiers'  homes,  cancer  in,  162 

Soot  and  cancer,  49,  58,  61,  63,  70  (see 

chimney-sweeps) 
South  Africa,  Union  of,  703-704 
South  AustraHa,  138, 730-731 
South  Dakota,  426 
Southern  cities,  128,  234-235, 474 
Southern  statistics,  42 
Spain,  39,  107, 135,  693-694 
Spinsters,  cancer  among,  98  (see  conjugal 

condition) 
Spontaneous  cancers,  207 
Springfield,  Massachusetts,  128, 568-570 
Standard  death  certificate,  27 
Standard  population,  35 
Standardized  death  rates,  12,  13,  71,  107- 

108,  126-127, 129,  220 
Statistical  analysis,  principles  of,  3 

criticisms  of,  7,  22, 23,  25, 37, 41 

difficulties  of,  17 

elements  of,  11 

errors  of,  12, 18,  21,  25 

fallacies  of,  2,  3,  22,  23, 41, 43, 162 

limitations  of,  2,  21,  26, 41, 126,  141 

methodsof,  1,9. 11,27,145 

requirements  of,  76, 130-131 
Statistical  investigations,  34 
Statistical  research,  principles  of,  22,^217 
Statistical  studies,  value  of,  11 
Statistical  study  of  cancer  increase,  34 
Statistics  of  cancer,  3,  25,  26,  58,  81,  97-98, 
163,  171.  217,  224-264,  305-775 

by  duration,  166 

early  London,  23 

educational  value  of,  77, 103 

fundamental  law  of,  3 

hospital,  78, 158-163, 221 

inaccuracies  of,  16 

inadequacy  of,  130-131 

international,  106-108, 224-265, 305-775 

limitations  of ,  126 

need  of  scientific  study  of,  25-26  ■ 


occupational,.  48-76,  305-315 
by  organs  and  parts,  228-231,  316-775 
post-mortems,  160 
practical  utility  of,  218 
sources  of,  21 
standardization  of,  220 
supplementary  census  inquiry  of,  304 
Statistics  of  precancerous  conditions,  156 
Stockholm,  Sweden,  637 
Stomach,  cancer  of,  58,  119,  121,  158,  166. 
170,  176,  177,  179,  187,  210,  228- 
231,  236-265,  302-303 
estimated  mortahty  from,  77 
mortahty  from,  110-111,  114, 115,  158, 
159,  163 
Stomach,  diseases  of,  increase  in,  37 

ulcer  of,  110  (see  ulcer  and  gastric  ulcer) 

Stomach  and  liver,  cancer  of,  15,  110-111, 

123.  130, 139 

international  statistics  of,  228-231,  236- 

265 

Stomach,  Uver  and  oesophagus,  cancer  of, 

122-125 
Stone  cancer,  168 
Straits  Settlements,  hospital  statistics  of, 

711 
Street-cleaners,  314 
Sudanese,  cancer  among,  136 
Suicide  and  cancer,  146 
Suicide,  mortahty  from,  440-441 
Sulphate  of  ammonia  and  cancer,  64 
Sulphmic  acid  and  cancer,  63-65  (see  smoke 

and  soot) 
Sulphiiric  substances  and  cancer,  174 
Surgery,  observations  on,  128 
Surgical  aspects  of  cancer,  162, 163, 164, 220 
Surgical  infection,  206-207 
Surgical  operations  in  cancer,  5,  6,  146, 157, 
162,  206,  288-289 
effect  on  cancer  death  rate  of,  40 
results  of,  210 
Swamps  and  cancer,  197    (see  dampness 

and  rainfall) 
Sweden,  40, 135,  634-636 

cancer  census  of,  76, 635-636 
Sweden  and  Finland,  641 
Swellings,  clinical  significance  of,  169-170 
definition  of,  5 
differential  diagnosis  of,  5 
Swiss  Goitre  Commission,  180 
Switzerland,  40,  46,  134,  135,  136, 167,  219, 
248-249,  415,  674-677 
cancer  in,  by  organs  and  parts,  123-125 
deaths  from  sarcoma  in,  167 
excessive  cancer  mortality  of,  134 
Sydney,  New  South  Wales,  726-727 
SjTnptoms,  early,  importance  of,  169-170, 
212-215 
clinical,  171  (see  diagnosis) 
Synthetic-dye  industry,  68  (see  aniline-dye 

workers) 
SyphUis  and  cancer,  116-121, 187,  188-190, 
220 


824 


INDEX  OF  SUBJECTS 


Tabulation  and  analysis,  uniformity  in,  2, 

26,27 
Tailors,  71,  72,  306-312,  315 
Tamils,  cancer  among,  15,  710 
Tanchou,  cancer  theory  of,  23 
Tanners,  73,  306-313 
Tar  and  paraffin  workers,  49,  50,  54,  56,  59, 

61,  70  (see  patent-fuel  industry) 
Tasmania,  138, 733-734 
Teachers,  71,  72,  306-312,  314 
Teeth,  defective,  and  cancer,  119-120 

and  cancer  of  tongue,  186 
Temperature,    mean     annual,     143     (see 

climate) 
Temperature  of  food  and  cancer,  215 
Terminal    diagnosis,  accuracy  of,  22,  170 

(see  diagnosis) 
Terminology,  cancer,  diflBculties  of,  4  (see 

classification) 
Textile-workers,  71,  72,  74, 75,  306-313 
Thames  Valley,  cancer  in,  203 
Throat,  cancer  of,  119, 120 
Thyroid  carcinoma,  181-183  (see  goitre) 
Thyroid  gland,  hypertrophic  enlargement 

of,  180 
Tin-plate  workers,  65, 69,  70 
Tinsmiths,  313 

Tissue  tension,  theory  of  cancer,  205 
Tobacco,  effect  of,  135,  185-186  (see  smok- 
ing) 
Tobacconists,  306-313 
Tokyo, Japan,  717-718 
Tongue,  cancer  of,  120,  121,  135,  157,  184, 

185, 186  (see  buccal  ca\dty) 
Topography    and    cancer,    152,    191,   192, 

196-198,  203-204  (see  geology  and 

soil) 
Toronto,  Canada,  741-742 
Toxins,  specific  cancer,  177 
Transplanted  cancer  among  animals,  207 
Transportation  employees,  62,  74,  315 
Transvaal,  136 
Traumatism  and  cancer,   48,   49,  59,   60, 

116-121    (see  accidents,  irritation 

and  occupation) 
Treatment  of  cancer,  169, 171  (see  surgery, 

radium  and  cancer  cures) 
Trinidad,  750 
Tropics  (see  latitude) 
Trujillo,  Peru,  141,  761 
Tuberculosis  and  cancer,  45,  116-121,  187- 

188,  203,  206,  220 
Tuberculosis,  decline  in  mortality  from,  46, 

188 
in  husband  and  wife,  206 
mortality     from,     188,    440-441     (see 

phthisis) 
Tucuman,  province  of,  Argentina,  771 
Tumor,  mortaUty  from,   1,  109,  110,  111, 
benign,  4, 109, 155,  428-429 
of  bladder,  59 
characteristics  of,  4 
classification  of,  8-11,  22, 167,  267-283 


definition  of,  4 

in  early  life,  14 

early  mortality  from,  7 

encysted,  6 

formation  and  trauma,  60 

Frankfurt  a/M.,   mortality    from  in, 
32.33 

literature  on,  4 

non-malignant,  classification  of,  20 

non-malignant,  definition  of,  4 

non-malignant,    mortality     from,    37, 
428-429 

and  occupation,  48 

old  age,  in  extreme,  14 

pathology  of,  6 

problem,  involved  nature  of,  167 
Turin,  Italy,  692 
Turkey,  185 
Turpentine- workers,  51 
Typhoid  fever,  mortality  from,  440-441 

Ulcer,  gastric,  156 

of  intestines,  increase  in,  37 
mortality  from,  429 
precancerous  nature  of,  156 
of  stomach,  38,  281 
Ulcers  and  cancerous  complaints,  6 
decrease  in  mortality  from,  37 
management  of,  22 
Underfeeding    and    cancer,    176    (see  diet 

and  malnutrition) 
Undertakers,  314 

Underweight  and  cancer,  220  (see  anthro- 
pometry,  nutrition,   obesity    and 
weight) 
Uniformity  in  statistics,  26,  27,  218 
Union  of  South  Africa,  703-704 
United  Kingdom  (see  England  and  Wales) 
United  States,  12,  40,  77, 107, 108, 114, 123- 
125,    126-132,    139-141,    230-233, 
238-239,  418-581 
estimated  mortaUty  from  cancer  in,  77, 

146 
states  and  cities  of,  450-581 
United  States  Bureau  of  Mines,  212 
United  States  Fish  Commission,  goitre  re- 
search of,  180-181 
United   States   Registration  Area,  cancer 
mortality  of,  by  organs  and  parts, 
123-125  (see  United  States) 
cancer  statistics  of,  in  detail,  418-449 
Upholsterers,  72,  313 
Urban  cancer  death  rate  (see  cities) 
Urban    cancer  mortaHty  of  England  and 

Wales,  602 
Urban  and  rural  cancer  death   rates,   13, 

431,  602,  633 
Urban  standardized  cancer  death  rates,  13 
Urinary  organs,  32,  33 

Uruguay,  39, 123-125, 140-141, 256-257, 416, 
774-775 
cancer  in,  by  organs  and  parts,  123-125 
Utah,  426 


823 


INDEX  OF  SUBJECTS 


Uterine  cancer,  149, 154, 158  (see  generative 

organs) 
and  syphilis,  189 
Uterine  cancer  blank,  296-297 
Uterine  tumors,  benign,  110,  280,  429 
Uterus,  cancer  of,  99,  100,  101,  110,  111, 

115,  120,  121,  154,  157-158,  166, 

169, 171, 174,  212,  214,  215,  216 
among  Jewesses,  148,  149,  150,   151, 

688  (see  conjugal  condition) 

Vagina,  cancer  of,  120-121 
Variations  in  cancer  frequency,  125, 147 
Vascular- tissue  type  of  cancer,  10 
Vegetarianism  and  cancer,  136,  138,  175, 

176,  178,  179  (see  diet) 
Venereal  disease  and  cancer,  116-121 
Venezuela,  140-141,  760 
Vermont,  108,  425, 470-471 
Victoria,  Australia,  138, 727-729 
Vienna,  Austria,  136,  681-683 

cancer  mortality  of  Jews  in,  149-150 
Vienna  General  Hospital,  194 
Virchow,  cancer  theory  of,  6, 202 
Vital  statistics,  3-4,  19,  22,  34,  42,  44,  73, 

86,  122,  125,   131,   218,    305-775 

(see     statistics,     mortaUty     and 

autopsy  records) 
Vulva,  cancer  of,  56 

Wagon-makees  and  wheelwrights,  313 

Waiters,  314-315 

Walshe,  cancer  treatise  of,  6,  7 
cancer  classification  of,  268 

Warsaw,  Russia,  698 

Warts  and  cancer,  187, 782 

Washington,  108, 426 

Washington,  D.  C.  (see  District  of  Colum- 
bia) 

Watchmen,  314 

Water  and  cancer,  152,  172, 199 

Water  and  goitre,  180 

Water  courses  and  cancer,  204  (see  Thames 
Valley) 


Wealthy,  cancer  among,  122,  150-151  (see 
poverty  and  wealth,  social  con- 
dition and  well-to-do) 

Weight  and  cancer,  97,  169 

Weight  and  uterine  cancer,  154  (see  an- 
thropometry, obesity,  overweight, 
physical  condition,  underweight, 
etc.) 

Well-to-do,  cancer  among,  55,  56,  90,  91, 
101  (see  poverty  and  wealth, 
also  wealthy) 

Western  Australia,  138, 734-735 

Western  Hemisphere,  139-141 

cancer  mortahty,  by  latitude,  142-144 

West  Indies,  80,  140 

Whiskey-drinking  and  cancer,  183 

White,  cancer  classification  of,  7,  10-11,  272 

White  and  colored,  cancer  among  (see  race) 

Widowed  and  divorced,  cancer  among,  98 
(see  conjugal  condition) 

Windward  and  Leeward  Islands,  750 

Wine-drinking  and  cancer,  183 

Winnipeg,  Canada,  744 

Wisconsin,  108, 426 

cancer  census  of,  35 

Womb,  cancer  of,  215  (see  uterus) 

Wood-workers,  62, 74 

Workmen's  compensation  and  cancer,  48, 50, 
51,  59  (see  occupational  disease) 

World,  cancer  mortality  of  civilized,  106- 
107,  146, 224-264,  305-775 
population  of,  estimate  of,  21 

Worry  and  cancer,  207-208,  220  (see  in- 
sanity) 

WUrttemberg,  Germany,  104,  648 

X-EAT  dermatitis,  59,  66,  122,  174,  175, 
184,  211 

X-ray  treatment,  211 

X-ray  workers,  66-67,  122  (see  Roentgen- 
rays  and  protective  regulations) 

ZuEicH,  Switzerland,  678 


826 


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